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Isolated systolic hypertension and ageing is common in Cuba too and we wish to share our more recent results.
Cienfuegos is the demonstration area for the Action Plan for the Multifactorial Reduction of Noncommunicable Diseases in Cuba. As a part of this project, a baseline was taken to obtain up-to-date information on the prevalence and control levels of hypertension (HBP). There are 76,803 inhab...
Cienfuegos is the demonstration area for the Action Plan for the Multifactorial Reduction of Noncommunicable Diseases in Cuba. As a part of this project, a baseline was taken to obtain up-to-date information on the prevalence and control levels of hypertension (HBP). There are 76,803 inhabitants between the ages of 25 and 74. This study was cross-sectional, based on a population sample of 1,475 people, selected randomly. The sample population was then separated by gender and age (25-44, 45-64, 65-74 years). The rate of participation in the clinical examination was 80%.
Cuba has a universal health system that provides high-quality services at no cost to most of the population, which has proven to be highly effective in hypertension control. (1-2)
HBP prevalence in the study population was 21.4% (Confidence Interval 95% 17,5-25,3). In this study, 39.9% (CI 95% 33,1-46,6) of individuals were found to have controlled HBP. In the 65-74 age group, which has the highest prevalence of HBP (56.6%), also has a greater
proportion of individuals who seek treatment. A considerable proportion of people with HBP between 65 and 74 years, in the categories of examined HBP, had confirmed isolated systolic hypertension (ISH) presence: HBP present
but subject is unaware = 76,4% of ISH (CI95% 59,4-93,5), HBP condition known but subject does not receive treatment = 40,5% (CI 25,9-55,0) and, HBP treated, hypertension controlled 60,7% (CI 48,0-73,5). However, this group’s relative risk was moderately high due to uncontrolled HBP, (> 65 years) but only 3% of individuals with HBP that did not know of their condition and 9% of those who were receiving treatment were uncontrolled.
Hence, the principal challenge for the group > 65 years, is dealing with a higher prevalence of HBP and confronting a greater risk of short-term cardiovascular complications. It is also necessary to identify an effective therapeutic regimen for reaching the goal of controlling hypertension, despite the persistent controversy concerning the ease with
which one can achieve a SBP level lower than 140 mmHg.(3)
There is another element which was not quantified in this study but contributes, in other scenarios, to the high frequency of uncontrolled hypertension. This element could explain, in a context such as the one found in Cuba, that with broad coverage and access, approximately half of
individuals with treated but uncontrolled hypertension showed mild cases of hypertension and the rates of control in the elderly were lower. It has to with the so-called therapeutic inertia.(4)
1. Cooper RS, Ordúñez P, Iraola-Ferrer M, Bernal JL, Espinosa A.
Cardiovascular disease and associated risk factors in Cuba: Prospects for
prevention and control. Am J Public Health 2006;96:94-101.
2. Orduñez P, Munoz JLB, Pedraza D, Silva LC, Espinoza-Brito A,
Cooper RS. Success in control of hypertension in a low-resource setting:
the Cuban experience. J Hypertens 2006;24:845-849.
3. Pinto E. Blood pressure and ageing. Postgraduate Medical Journal
4. Okonofua EC; Simpson KN; Jesri A; Rehman SU; Durkalski VL; Egan
BM. Therapeutic Inertia Is an Impediment to Achieving the Healthy People
2010 Blood Pressure Control Goals. Hypertension 2006;47:345.