PS-P04-1: RISK FACTOR PROFILE AND LACK OF TREATMENT INTENSIFICATION AS A MAIN FACTOR OF INCREASED STROKE MORTALITY IN BULGARIA

Abstract

Objective: Bulgaria is one of the leading countries in terms of premature mortality due to stroke with 6406,4 years of life lost per 100000 (95% CI 5211,7 to 7763,4) according to the data from Global Burden of Disease for 2019. In the same year The May Measurement Month (MMM) initiative was implemented in the country aiming to raise hypertension awareness and control. The aim of the study was to identify whether national-level MMM hypertension parameters are associated with national stroke mortality statistics. Design and method: Three BP readings and self-reported demographic, lifestyle and cardiovascular risk factors were collected from 3678 participants during MMM2019 campaign. National stroke mortality statistics and Socio-Demographic Index (SDI) were extracted from the Global Burden of Disease (GBD) study 2019. Hypertension was defined as a raised BP (systolic BP > 140 mmHg or diastolic BP > 90 mmHg based on the mean of the second and third readings), or on antihypertensive medication. Logistic and linear regression were applied, respectively, to the association between hypertension and stroke and between national-level GBD stroke mortality with MMM proportions with raised, treated and uncontrolled BP. Results: Overall we notice a relatively high proportion of participants with a previous stroke 237 (6.4%). Stroke survivors were older (69 vs 58,1, p < 0.001), with higher levels of systolic BP (139,4 vs 134,9 mmHg), but lower diastolic BP (80,2 vs 82,5 mmHg) and significantly more frequent concomitant coronary and peripheral arterial diseases, diabetes or heart failure (p < 0.001 for all). The proportion with previous atrial fibrillation was also higher among previous stroke patients 13,9 vs 5,6%. Stroke mortality increased, on average, by 680 per 100,000 per 1% increase in the proportion of individuals with raised BP (p = 0.006) and by 909 per 100,000 per 1% increase in proportion with treated but uncontrolled BP (p = 0.012). The corresponding years of life lost due to ischemic stroke were 736 (p = 0.015) and 172 per 100000 (p = 0.0005) due to hemorrhagic stroke per 1% increase in proportion with suboptimally treated BP. Conclusions: There was a significant association between national stroke mortality from GBD and the proportions of participants with raised BP and of hypertensives treated but uncontrolled in MMM. This suggests that despite lacking a population-based design, estimates from MMM broadly reflect rates of downstream mortality and that opportunistic screening can be an effective means not only of screening for hypertension, but of improving control of the patients already treated. The data presented gives rational for using estimates to inform policy and to start national campaign in order to change the existing tendencies.