LIJEČENJE I KONTROLA ARTERIJSKE HIPERTENZIJE U HRVATSKOJ. BEL-AH ISTRAŽIVANJE

BOJAN JELAKOVIĆ, ŽIVKA DIKA, JELENA KOS, IVAN PEĆIN, MARIO LAGANOVIĆ, ALEKSANDAR JOVANOVIĆ, TOMISLAV ŠMUC, DRAGAN GAMBERGER, DUŠKO KUZMANIĆ

Nedovoljna kontrola arterijskoga tlaka (AT) jedan je od bitnih razloga nepostignutog smanjivanja kardiovaskular­nog (KV) pobola i smrtnosti. Cilj ovog rada je analizirati postignutu kontrolu AT u ordinacijama opće i obiteljske medicine u četiri najveća hrvatska grada. U istraživanje je uključeno 412 liječnika te 7031 bolesnik srednje dobi 62,9±1,5 godina. Sred­nje vrijednosti sistoličkog AT bile su 162,9±16,8 mmHg, a dijastoličkog AT 95,6±9,9 mmHg. Ne postoji statistički značajna razlika u visini ni sistoličkog (p=0,173) ni dijastoličkog tlaka (p=0,561) između muškaraca (m) i žena (ž). U cijeloj skupini kontrola arterijske hipertenzije (AH) postignuta je u 8% bolesnika. No, čak je 44,5% liječnika i 72% bolesnika zadovoljno postignutom kontrolom AT. Veći postotak muških hipertoničara od ženskih zadovoljan je ostvarenim vrijednostima (81,9%:66,9%). ITM (indeks tjelesne mase) <25 registriranje u 22,9% hipertoničara i uočena je statistički značajna razlika u ITM između muškaraca i žena (χ²=56,769, p<0,001). Registrirana je statistički značajna razlika u AH s obzirom na ITM i u muškaraca i u žena (χ_m²,=46,339, p<0,001; χ_ž²=45,992, p=0,024). S povećanjem ITM povećava se udio teške i umjerene AH, a smanjuje udio bolesnika s blagom AH i kontroliranim AT. ITM je povezan s brojem propisanih lijekova, pa tako bolesnici s ITM<25 u prosjeku dobivaju manje lijekova od bolesnika s ITM > 30 (1,4:1,6, p=0,001). Kontrola AH u Hrvatskoj je i prema ovom istraživanju vrlo loša. Na tako loš ishod, osim pretilosti koja snažno determinira težinu AH i kontrolu u oba spola, utječe i nedovoljna svijest bolesnika, ali i liječnika o potrebi strožeg snižavanja AT. Ovi rezultati upućuju na potrebu intenzivnije edukacije cijele naše populacije

Summary. Poor control of blood pressure (BP) is one of the main reasons for high cardiovascular mortality and morbidity. The aim of this study was to analyse control of BP in outpatient settings in four biggest towns in Croatia. The study included 412 medical doctors (GP) and 7031 middle-aged patients (62.9±11.5 years). Mean BP in treated patients was 162.9± 16.8/95.6±9.9 mmHg. There were no statistically significant differences in systolic (p=0.173) and diastolic (p=0.561) BP between men and women. In this group of patients only 8% achieved target BP values. In contrast, and surprisingly, 44.5% of medical doctors and 72% of patients were satisfied with obtained BP control. Higher percentage of male patients vs. female were satisfied with blood pressure control (81.9%:66.9%). BMI <25 was registered in 22.9% of hypertensive patients, and there was statistically significant difference in BMI between men and women (c2=56.769, p<0.001). In this study we found a statistically significant difference of hypertension in regard to BMI in both sexes (c2m=46.339, p<0.001; c2`=45.992, p=0.024). BMI was in correlation with severity of hypertension as well as with obtained treatment result. BMI was in correlation with the number of prescribed drugs. According to this, patients with BMI <25 were prescribed less drugs than those with BMI >30 (1.4:1,6 p=0.001). BP control in Croatia is, according to this study, very poor. The main reason for such situation is, beside obesity which determines the stage of hypertension and BP control in both sexes, insufficiently developed conscience in patients and doctors about the importance of stronger blood pressure control. The results indicate the necessity for the more intensive education of the population.