[show abstract][hide abstract] ABSTRACT: To describe self-reported hypertension treatment among primary care physicians in central and eastern Europe and to investigate international differences.
A cross-sectional survey of primary care physicians with a questionnaire translated into various languages was carried out in nine central and eastern European countries. Three thousand physicians were randomly selected from the national registers.
Eight hundred and sixty-seven invited primary care physicians responded. For the patients with hypertension and low cardiovascular risk, 49% of physicians reported a treatment goal of less than 140/90 mmHg (69% in Slovenia, 20% in Latvia, P < 0.001). In patients with hypertension and diabetes mellitus, blood pressure (BP) targets of less than 130/80 mmHg and less than 120/80 mmHg were reported by 47 and 48% of physicians, respectively, and significant differences between countries were revealed. Angiotensin-converting enzyme inhibitors were the most common declared drugs used on a daily basis (over 90% of physicians in all countries). Various international differences were observed among the use of diuretics, β-blockers and drugs from other classes. An immediate initiation of pharmacotherapy was declared by 24% of physicians at a SBP level of at least 180 mmHg and 20% at DBP level of at least 110 mmHg.
In hypertension treatment, some decisions made by primary care physicians from central and eastern European countries are still done without any supporting evidence from clinical trials. They have declared lower treatment goals and the initiation of pharmacotherapy at lower BP levels than recommended in international guidelines. An innovative approach to continuous medical education should be introduced and the efforts to implement guidelines in everyday practice ought to continue.
Journal of hypertension 06/2012; 30(8):1671-8. · 4.02 Impact Factor
[show abstract][hide abstract] ABSTRACT: To determine: (1) achievement of cholesterol therapy goals in patients receiving lipid-lowering drugs in Polish primary care between the years 2004 and 2006; (2) the characteristics of patients that are associated with attainment of these goals.
Cross-sectional study in randomly selected Polish primary care practices.
5248 patients aged over 30 years in 2004 and 5386 patients in 2006, who were taking cholesterol-lowering treatment took part in the study. Physicians recorded demographic and medical history data using a standardized questionnaire, including weight and height, and collected blood samples of patients to determine their cholesterol level.
18.5% of patients attained their optimal goals of therapy (total cholesterol, TC; low-density lipoprotein cholesterol, LDL-C) in 2004 compared to 25.2% in 2006 (p < 0.001). In both 2004 and 2006, more patients achieved their target levels for LDL-C than for TC and statins were the most commonly used medication (85% and 91%, respectively). Male sex, smoking, and higher education were the strongest correlates of the therapeutic outcome. The odds ratio of achieving cholesterol therapy goals in men, non-smokers, and university graduates was estimated at 1.51, 0.70, 1.38 in 2004 and 1.50, 0.73, 1.34 in 2006, respectively.
There was a measurable improvement in the effectiveness of hypercholesterolaemia treatment between 2004 and 2006 but the majority of patients remain inadequately treated, with goals not being achieved. There is a need to raise the standard of lipid-lowering management in Poland.
European journal of cardiovascular prevention and rehabilitation: official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology 04/2011; 18(2):287-96. · 2.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: Excessive body weight is known to cluster with cardiovascular (CV) risk factors, but it is not clear which anthropometric obesity measure provides best independent predictive value of coronary artery disease (CAD).
We explored associations between CAD and four different obesity measures (body mass index (BMI), waist circumference, waist/height and waist/height(2)) in a cohort of 16 657 subjects (40.4% men; 20.8% CAD patients), recruited by 700 primary care physicians in 444 Polish cities. 42.8% of subjects were classified as overweight, 31.7% as obese and 39.8% had abdominal obesity. In univariate analyses all obesity measures correlated with CAD (p>0.001), but waist/height(2) was the strongest discriminator between CAD patients and controls. Age-adjusted and sex-adjusted analyses confirmed a graded increase in CAD risk across distributions of all four obesity measures-1 standard deviation (SD) increase in BMI, waist, waist/height and waist/height(2) increased the odds of CAD by 1.23, 1.24, 1.26 and 1.27, respectively (all p<0.001). In models fully adjusted for CV risk factors, waist/height(2) remained the strongest obesity correlate of CAD, being the only independent associate of CAD in men. In a fully adjusted BMI-waist circumference stratified model, sarcopenic obesity (waist > median, BMI < median) and simple obesity (waist and BMI > median) were the strongest independent associates of CAD in men (p = 0.008) and women (p>0.001), respectively.
This cross-sectional study showed that waist/height(2) may potentially offer a slightly higher predictive value of CAD than BMI or waist circumference and revealed an apparent sexual dimorphism in correlations between obesity measures and CAD.