Poland and U.S. Collaborative Study on Cardiovascular Epidemiology Hypertension in the Community: Prevalence, Awareness, Treatment, and Control of Hypertension in the Pol-MONICA Project and the U.S. Atherosclerosis Risk in Communities Study

Abstract

PURPOSE: The objectives of this manuscript are to assess differences in blood pressure levels and in hypertension prevalence, awareness, treatment, and control for selected rural and urban areas in the U.S. and Poland, where ischemic heart disease mortality trends are different.METHODS: Included are white persons aged 45–64 selected in Minneapolis, MN suburbs [urban] and Washington County, MD [semi-rural] from the U.S. Atherosclerosis Risk in Communities Study (ARIC) surveyed in 1987–89, and in Warsaw [urban] and Tarnobrzeg Province [semi-rural] from Poland's Pol-MONICA Project surveyed in 1987–88. Sample sizes were: U.S.—3,696 men, 3,801 women; Poland—875 men, 960 women.RESULTS: Mean blood pressures were > 15% higher for Polish samples than for the U.S. (p < 0.01). In multivariable analysis, hypertension was significantly positively related to age and body mass index (BMI) in both U.S. and Polish samples (except age in Polish men), and to heart rate in Polish samples and U.S. rural women. Smoking was significantly negatively related to hypertension in urban Polish and rural U.S. men. Hypertension awareness, treatment, and control were better in U.S. than in Polish samples. In the U.S. > 80% of subjects with hypertension (systolic blood pressure (SBP) ⩾ 160 mmHg or diastolic blood pressure (DBP) ⩾ 95 mmHg or on treatment) were controlled whereas in Polish samples ⩽ 17% of hypertensive men and 16% of hypertensive women were controlled. When SBP ⩾ 140 mmHg or DBP ⩾ 90 mmHg or on treatment defined hypertension, control was about 55% in U.S. samples and about 2% in Polish samples.CONCLUSIONS: Hypertension prevalence is higher and blood pressure levels are less well controlled in Polish than in U.S. samples. These striking differences can be expected to contribute to opposing trends in coronary heart disease (CHD) mortality in the two countries. Hypertension control programs in the U.S. are almost certainly responsible for much of the observed differences. There is a clear need for similar programs in Poland.