[Show abstract][Hide abstract] ABSTRACT: Objectives: To assess longitudinal trends in cardiovascular mortality and population mean blood pressure, prevalence, awareness, treatment, and control of hypertension in a representative Czech population sample from 1985 to 2007/2008.
Methods: Source data on mortality rates were provided by the Czech Statistical Office and further processed by the Institute for Health Information and Statistics of the Czech Republic. Six independent cross-sectional population surveys were conducted in 1985, 1988, 1992, 1997/1998, 2000/2001, and 2007/2008 with randomly selected men and women aged 25–64 years and resident in six districts of the Czech Republic (Praha-východ, Benešov, Pardubice, Chrudim, Cheb, and Jindřichův Hradec). The total number of participants was 13 972.
Results: Since 1985, there has been a significant continuous, almost linear decline in standardized total, cardiovascular disease, ischemic heart disease, and stroke mortality (P < 0.001).
There was a significant downward trend in the population mean SBP (from 133.6 ± 20.2 to 129.5 ± 18.5 mmHg; P < 0.001) and DBP (from 84.1 ± 11.3 to 82.5 ± 10.0 mmHg; P < 0.001) from 1985 to 2007/2008. This was associated with a significant decrease in the prevalence of hypertension only in women (from 42.5 to 37.2%; P < 0.001). Awareness of hypertension increased in both sexes (men, from 41.4 to 68.4%; women, from 58.9 to 71.4%; both P < 0.001) as did the number of individuals on antihypertensive medication (men, from 21.1 to 58.2%, women: from 38.9 to 58.9%; both P < 0.001). Control of hypertension improved significantly (from 3.9 to 24.6%) over the same period.
Conclusion: The reduction in population blood pressure and improved hypertension control may have contributed substantially to the decrease in cardiovascular disease mortality in the Czech Republic.
Journal of Hypertension 10/2010; 28(11):2196–2203. · 4.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Because of the general in availability of reference standards, there exist no common procedures to assess the quality of blood pressure measurements in epidemiological population surveys. To approach this problem within the collaborative international WHO MONICA Project, a standardized assessment of BP measurement quality was developed and applied to the forty-seven baseline surveys of that project. The entire assessments were carried out in retrospect, that is, only after each population survey had been completed. The assessment was focused on the procedures of quality assurance and control as reportedly applied in each survey, and on quality indicators which were derived from the recorded blood pressure values of each survey. The definitions of specific quality assessment items were based on the MONICA project protocol and on sources in the pertinent literature. The available information on quality assurance and control procedures depended solely on self-reports by local survey organizers and on site visits, and was occasionally found to be at variance with the actual blood pressure recordings. Therefore, quality indicators derived from actual blood pressure recordings were far more informative and comparable between surveys. Each survey was rated as optimal, satisfactory, or unsatisfactory with regard to single quality items and these single scores were used jointly to compute a summary score of blood pressure measurement quality for each survey. This summary score indicated that 39 out of 47 MONICA baseline surveys showed optimal or satisfactory BP measurement quality. Limitations and potentials for improvement of quality assessments became apparent. We conclude that a standardized assessment of BP measurement quality in epidemiological population surveys seems feasible and propose that quality assessment methods similar to the ones suggested here become a routine part of future epidemiological analyses of blood pressure values and hypertension in populations. This should facilitate valid study comparisons.
Journal of Human Hypertension 12/1995; 9(12):935-46. · 2.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In the Who Monica Project mortality and morbidity from acute myocardial infarction is being monitored in 39 Collaborating Centres in 26 countries for a period of 10 years. The myocardial infarction registration procedures have been standardized and suspect coronary events are classified into diagnostic categories according to common criteria. This paper presents ischaemic heart disease mortality figures, based on routine statistics for the study populations and discusses cross-sectional comparability of morbidity data from event registration. Because of differences in availability of data used for diagnostic classification of events (such as autopsy data) the proportions of different diagnostic categories vary from centre to centre. There are, therefore, problems in cross-sectional comparison of morbidity data between the centres. The primary target of event registration in the project is to monitor morbidity changes within centres during the ten-year period. This goal should not be affected by the problems described in this paper.
International Journal of Epidemiology 03/1989; 18(Supplement 1):S38-S45. · 6.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Who Monica Project is a multicenter international collaborative project coordinated by the World Health Organization. Its objective is to measure trends in cardiovascular mortality and morbidity and to assess the extent to which these trends are related to changes in risk factor levels and/or medical care, measured at the same time in defined communities in different countries. Thirty-nine collaborating centers from 26 countries of Europe, North America, and the Western Pacific collaborate in this project, using a standardized protocol and covering a population of approximately 10 million men and women aged 35–64. The WHO Monica Project is directed by the Council of Principal Investigators and a Steering Committee, and it is managed by a Management Centre, Data Centre, Quality Control Centers (for event registration, ECG coding and lipid determinations) and Reference Centers (for optional studies). The Monica methodology is increasingly used as a measurement tool for cardiovascular and non-communicable diseases prevention and control programs by centers within and outside the project.
International Journal of Epidemiology 03/1989; 18(Supplement 1):S29-S37. · 6.98 Impact Factor