Hypertension and associated cardiovascular risk factors in Romania

Download PDF

Pr. Sverre E. Kjeldsen1

1 Department of Cardiology, Oslo University Hospital, Ullevaal, Oslo, Norway
For The Romanian Journal of Cardiology, Updated September 23, 2019

The Study for the Evaluation of Prevalence of Hyper-tension and Cardiovascular Risk in Romania, SEPHAR, has shown in repeated national cross sectional sur-veys, performed in 2005, 2012 and 2016, that Romania is a country with prevalence of hypertension as high as 45%1-4. Romania is a typical East European country with high prevalence of also other cardiovascular risk factors1-4.
In this issue of the Romanian Journal of Cardiology the SEPHAR investigators aimed to investigate the Ro-manian prevalence of high normal blood pressure (BP) and to investigate whether people with high normal BP have higher prevalence of other cardiovascular risk factors compared to people with normal BP5. Knowing that the number one cause of death in Romania is car-diovascular, they collected this information in order to provide a basis for national preventives strategies against hypertension and cardiovascular disease.
A representative sample of Romanian adults was enrolled in the SEPHAR III survey. During the two study visits, the 1970 participants had their BP taken 3 times according to current guidelines and the enrol-led individuals responded to a questionnaire, anthro-pometric measurements were performed, and the in-vestigators did an extensive evaluation of target organ damage, blood work, and urinalysis.
The prevalence of high normal BP was 11%. Indivi-duals with high normal BP were older (mean age 51 yrs.) than individuals with normal BP (mean age 41 yrs.) but they were younger than those with established hypertension (mean age 56 yrs.). Body weight, waist circumference, body mass index, total and low density lipoprotein cholesterol, fasting triglycerides, fasting blood glucose, glycosylated haemoglobin (HbA1c), se-rum uric acid, serum creatinine, urinary albumin/creatinine ratio, carotid intimae-media thickness, arterial stiffness and cardiac diastolic dysfunction, left ventri-cular mass index, interventricular septum and poste-rior left ventricle wall thickness and left atrial volume were significantly higher in participants high normal BP compared to participants with normal BP.
In short, people in Romania with high normal BP re-present approximately 11% of the population and they had elevated cardiovascular risk. From these data the authors suggest that it is essential to educate the ge-neral public and the health care providers to be aware of these individuals and implement steps that should be taken to improve their cardiovascular risk factors.
Thus, the national situation has been described in Romania and this is an important first step in the work with creating awareness and initiating activities to im-prove the situations with the untoward high cardio-vascular risk factors in the country. Of course in this context the message from the SEPHAR investigators is to properly treat hypertension and keep an eye on BP in all the people with high normal values. Over time they tend to develop established hypertension in need of antihypertensive drug treatment. However, a more aggressive attitude may be indicated; the most recent European Hypertension Guidelines6 recommend drug treatment also in people with high normal BP and concomitant high cardiovascular risk. This is especially the case in people with hypertension mediated organ damage, here refered to as “target organ damage”5. Many of these people may have masked hypertension, elevated BP at ambulatory measurements, and anti-hypertensive drug treatment is indicated7-9.
Further, aggressive antismoking activities, promo-ting more physical activity and weight control and recommending a healthy diet10,11 are also natural consequences of the SEPHAR fi ndings. Possible, or maybe most likely, also in Romania the cardiovascular risk factors including the situation with high normal BP or established hypertension may be rapidly improved such as in the Nordic countries which were conside-red high risk countries in Europe not too many years ago but now have successfully moved into the low risk category regarding cardiovascular diseases12.

Conflict of interest: none declared.

1. Dorobanţu M, Darabont R, Ghiorghe S, et al. Hypertension preva-lence and control in Romania at a seven-year interval. Comparison of SEPHAR I and II surveys. J Hypertens 2014; 32: 39-47.
2. Dorobantu M, Darabont RO, Badila E, Ghiorghe S. Prevalence, awareness, treatment, and control of hypertension in Romania: re-sults of the SEPHAR study. Int J Hypertension 2010; 970694, https:// doi.org/10.4061/2010/970694
3. Dorobantu M, Darabont R, Dimulescu D, et al. New national epide-miological survey for the assessment of trend in hypertension’s prev-alence, treatment and control among the adult population of Roma-nia: SEPHAR III: design and methodology. J Hypertens Res 2016; 2: 143-152.
4. Dorobantu M, Tautu OF, Dimulescu D, et al. Perspectives on hyper-tension’s prevalence, treatment and control in a high cardiovascular risk East European country: data from the SEPHAR III survey. J Hy-pertens 2018; 36: 690-700.
5. Pop C, Florentina O, Fronea G, et al. Prevalence of high-normal blood pressure and associated risk factors among the adult popula-tion from a very-high cardiovascular risk country. Romanian J Car-diol 2019; in press
6. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement D, Coca A, De Simone G, Dominiczak A, Kahan T, Mah-foud F, Redon J, Ruilope L, Zanchetti A, et al. 2018 Practice guide-lines for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hyperten-sion (ESH). Blood Press 2018; 27: 314-340.
7. Cuspidi C, Sala C, Tadic M, Rescaldani M, Grassi G, Mancia G. Un-treated masked hypertension and subclinical cardiac damage: A sys-tematic review and meta-analysis. Am J Hypertens 2015; 28: 806-8013.
8. Kjeldsen SE, Os I. Are people with masked hypertension adher-ent to their antihypertensive medication? Hypertension 2019 Jul 22:HYPERTENSIONAHA11913350. doi: 10.1161/HYPERTENSIO-NAHA.119.13350. [Epub ahead of print]
9. Kjeldsen SE, Os I. Poor reproducibility of masked and white coat un-controlled hypertension – important new information on MUCH and WUCH. Eur Heart J 2019; in press.
10. Estruch R, Ros E, Salas-Salvadó J, Covas M-I, Corella D, Arós F, Gó-mez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Martinez-Gonzalez MA, PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; 368: 1279–1290.
11. Larstorp AC, Tonstad S. Effect of a Low Fat Diet Intervention on Blood Pressure and Hypertension: Rather Switch to a Mediterra-nean Diet? Am J Hypertens, doi:10.1093/ajh/hpw054
12. Kjeldsen SE, Aksnes TA, Mo R, Klemsdal T-O. Impact of the New ACC/AHA and ESC/ESH Hypertension Guidelines for Norway. Eur Heart J 2019, doi:10.1093/eurheartj/ehz266.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
ESC search engine
CODE: 379
CME Credits: 10 (Romanian College of Physicians)
This work is licensed under a Creative Commons Attribution 4.0 International License.