The epidemiology of hypertension control in populations

Rationale and public health implications of changing CHD risk factor definitions

The definition of disease is central to the practice of medicine and to public health policy. Practice guidelines set standards for disease identification and treatment. Quality care is often defined as adherence to these guidelines. Over the past few years, the diagnostic thresholds for several common medical conditions have been lowered, resulting in a substantial expansion in the market for health care. The most recent guidelines for high blood pressure, high cholesterol, and impaired fasting glucose each define a high percentage of the adult population as in need of regular medical attention. Under the latest proposed thresholds, virtually the entire adult population qualifies for a chronic condition diagnosis. We evaluate the health and financial outcomes associated with changes in diagnostic thresholds for the prevention of three risk factors for cardiovascular disease and stroke: blood pressure, serum cholesterol, and fasting plasma glucose. Estimates of the numbers of people affected, the cost implications, and the overall public health consequences are offered.

Prevalence, treatment, control, and awareness of high blood pressure and the risk of stroke in Northwest England

OBJECTIVES

The aim of this study was to examine the prevalence, treatment, control, and awareness of hypertension in patients with first-ever stroke and in controls sampled from the same primary care physician's population register.

METHODS

A population-based case-control study was conducted in East Lancashire, England, using cases identified from the stroke register in 1994-1995. Information on blood pressure (BP) and other predefined factors was extracted from the practice medical records. Postal questionnaires were used for information on patients' awareness of hypertension.

RESULTS

A total of 267 stroke cases and 534 controls were included. Sixty-one percent of cases and 43% of controls had BP >= 160/95 mm Hg on >= 2 occasions within 3 months or received antihypertensives. High proportions of cases (82%) and controls (85%) were on treatment. There was a continuous relationship between the risk of stroke and levels of BP control. Of 73 cases and 135 controls who were hypertensive and responded to the postal questionnaire, 56 and 83%, respectively, were aware of hypertension (P<0.01).

CONCLUSIONS

The prevalence of hypertension was high among stroke patients. In those treated, <30% of patients had their BP adequately controlled to <140/90 mm Hg. Patient awareness of previous hypertension or high BP was very poor and attention needs to be paid to patient education.

Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus. Putting evidence into practice

PURPOSE

To summarise current knowledge of interventions that should improve the care of patients with type II diabetes mellitus. Interventions lie within the realms of preventions, screening, and treatment, all of which are focused on office practice.

METHODS

Review of the literature by a multidisciplinary team involved in the care of patients with diabetes, followed by synthesis of the literature into a clinical care guideline. Literature was identified through consultation with experts and a focused MEDLINE search.

MAIN RESULTS

An algorithm-based guideline for screening and treatment of the complications of diabetes was developed. The emphasis is on prevention of atherosclerotic disease, and prevention, screening, and early treatment of microvascular disease. Implementation of these practices has the potential to significantly improve quality of life and increase life expectancy in patients with type II diabetes mellitus.