BACKGROUND: Coronary heart disease (CHD) death rates have fallen across most of Europe in recent decades. However, substantial risk factor reductions have not been achieved across all Europe. Our aim was to quantify the potential impact of future policy scenarios on diet and lifestyle on CHD mortality in 9 European countries. METHODS: We updated the previously validated IMPACT CHD models in 9 European countries and extended them to 2010-11 (the baseline year) to predict reductions in CHD mortality to 2020(ages 25-74years). We compared three scenarios: conservative, intermediate and optimistic on smoking prevalence (absolute decreases of 5%, 10% and 15%); saturated fat intake (1%, 2% and 3% absolute decreases in % energy intake, replaced by unsaturated fats); salt (relative decreases of 10%, 20% and 30%), and physical inactivity (absolute decreases of 5%, 10% and 15%). Probabilistic sensitivity analyses were conducted. RESULTS: Under the conservative, intermediate and optimistic scenarios, we estimated 10.8% (95% CI: 7.3-14.0), 20.7% (95% CI: 15.6-25.2) and 29.1% (95% CI: 22.6-35.0) fewer CHD deaths in 2020. For the optimistic scenario, 15% absolute reductions in smoking could decrease CHD deaths by 8.9%-11.6%, Salt intake relative reductions of 30% by approximately 5.9-8.9%; 3% reductions in saturated fat intake by 6.3-7.5%, and 15% absolute increases in physical activity by 3.7-5.3%. CONCLUSIONS: Modest and feasible policy-based reductions in cardiovascular risk factors (already been achieved in some other countries) could translate into substantial reductions in future CHD deaths across Europe. However, this would require the European Union to more effectively implement powerful evidence-based prevention policies.

• Klíčová slova
• Coronary heart disease, Food policy, Mortality trends, Physical activity, Policy modelling, Prevention, Smoking,
• MeSH
• dietní tuky * škodlivé účinky   MeSH
• dospělí MeSH
• kardiovaskulární nemoci dietoterapie   mortalita   prevence a kontrola   MeSH
• kouření škodlivé účinky   mortalita   trendy   MeSH
• kuchyňská sůl * škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mortalita trendy   MeSH
• rizikové faktory MeSH
• senioři MeSH
• stravovací zvyklosti MeSH
• teoretické modely * MeSH
• životní styl * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH
• Názvy látek
• dietní tuky * MeSH
• kuchyňská sůl * MeSH

BACKGROUND: Several studies have shown that antihypertensive monotherapy is commonly insufficient to control blood pressure (BP) in hypertensive patients and that concomitant use of ≥2 drugs is necessary in ∼50% of these patients. The combination of an angiotensin-converting enzyme (ACE) inhibitor and a diuretic, delapril plus indapamide (D + I), has been shown to be effective and tolerable, with no interaction between the 2 components. Another widely used combination of ACE inhibitor and diuretic is lisinopril plus hydrochlorothiazide (L + H). OBJECTIVES: The aims of this study were to confirm the antihypertensive efficacy and tolerability of the fixed combination of D + I in mild to moderate hypertension, and to compare its therapeutic efficacy and tolerability with that of L + H. METHODS: The antihypertensive efficacy and tolerability of a fixed combination of D + I (30-mg + 2.5-mg tablets once daily) or L + H (20-mg + 12.5-mg tablets once daily) in patients with mild to moderate hypertension were compared in a multinational, multicenter, randomized, 2-armed, parallel-group study. Eligible patients were aged 18 to 75 years and had a diastolic blood pressure (DBP) 95 to 115 mm Hg and a systolic blood pressure (SBP) ≤180 mm Hg, both measured in the sitting position. After a single-blind, placebo run-in period of 2 weeks, patients were randomized to receive 1 of the 2 treatments for a 12-week period. The primary efficacy end point was the BP normalization rate (ie, the percentage of patients with a sitting DBP ≤90 mm Hg) after 12 weeks of treatment. Secondary end points were as follows: (1) the responder rate (ie, the percentage of patients whose sitting DBP was reduced by ≥10 mm Hg from baseline or had a DBP ≤90 mm Hg after 12 weeks of treatment), (2) the percentage of patients with a DBP ≤85 mm Hg, and (3) changes in sitting SBP and DBP after 4, 8, and 12 weeks of treatment. RESULTS: A total of 159 hypertensive patients (88 women, 71 men) were randomized to receive D + I (44 women, 36 men; mean [SD] age, 53 [(11)] years) or L + H (44 women, 35 men; mean [SD] age, 55 [(10)] years). No significant between-group differences were found in any of the primary or secondary end points of the study. Both combinations induced a significant reduction in sitting DBP and SBP from baseline (P<0.001 for both groups at week 12), without significant differences between the groups. Five mild to moderate adverse drug reactions (ADRs) occurred in each treatment group. No patient dropped out of the study because of an ADR. CONCLUSION: This study showed no difference between D + I and L + H interms of antihypertensive efficacy or tolerability in patients with mild to moderate hypertension.

• Klíčová slova
• combination therapy, delapril, hydrochlorothiazide, hypertension, indapamide, lisinopril,
• Publikační typ
• časopisecké články MeSH

In the present pilot study an attempt was made to evaluate the usefulness of results obtained about the treatment of patients suffering from high blood pressure for a pharmacoepidemiological study of the therapeutic value of antihypertensive agents. Data from 90 hypertensive patients were used in the present retrospective-prospective study. These patients all attended an out-patient clinic located in one of the East-Bohemian districts that are participating in the MONICA programme. Instead of the analysis of the population data, regular blood pressure measurements, plasma glucose levels, and total cholesterol concentrations were measured and analysed. The consumption of various antihypertensive drugs in this study was similar to that found in larger studies performed in other health districts of the Czech Republic. Diuretics were the drugs most frequently prescribed for hypertensive patients. General practitioners rarely prescribed calcium channel blockers and angiotensin-converting enzyme inhibitors in 1990 and 1991. The metabolic effects of antihypertensive drugs, mostly diuretics, were not significantly evident. The most frequent occurrence of non-compensated blood pressure was recorded for the treatments with Trimecryton and methyldopa. However, the validity of these findings should be tested in a larger group of hypertensic patients.

• MeSH
• ambulantní péče MeSH
• antihypertenziva aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• beta blokátory aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• cholesterol krev   MeSH
• diuretika aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• dospělí MeSH
• hypertenze farmakoterapie   MeSH
• krevní glukóza účinky léků   metabolismus   MeSH
• krevní tlak účinky léků   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pilotní projekty MeSH
• prospektivní studie MeSH
• retrospektivní studie MeSH
• senioři MeSH
• vztahy mezi strukturou a aktivitou MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antihypertenziva MeSH
• beta blokátory MeSH
• cholesterol MeSH
• diuretika MeSH
• krevní glukóza MeSH