HYPERTENSION, CORONARY-ARTERY AND CEREBROVASCULAR DISEASES IN THE POPULATION - HAS EPIDEMIOLOGY CHANGED IN THE LAST DECADES

Life expectancy has significantly increased in the last decades in man y western populations, due to the fall of total and cardiovascular dea th rate. However, morbidity from cardiovascular diseases has decreased to a smaller extent. The overall population risk profile has improved , but it is still unsatisfactory. This is true for blood pressure cont rol (with only 20% of hypertensive patients achieving normotension wit h antihypertensive drugs), hypercholesterolemia (with bordeline-high s erum cholesterol levels in 50% of the population), and smoking habits. Other potential causes of the poor cardiovascular prevention are: 1) a limited knowledge of the optimal blood pressure goal with antihypert ensive treatment, 2) scanty information on the long term effects of an tihypertensive drugs on cerebral and coronary circulation. Finally, li ttle is being done to improve primary prevention in youth, when the sl owly progressing atherosclerotic plaque formation is already on the wa y. To improve the cost / effectiveness of cardiovascular prevention, e fforts must concentrate on the early identification of the subjects at the highest risk and on health promotion among youngsters. Large epid emiological trials conducted from the early 50s have provided convinci ng evidence of the multifactorial origin of cardiovascular diseases an d encouraged the implementation of population based primary and second ary preventive measures, including antihypertensive treatment, as well as dietary and life-style modifications. It is now time to start aski ng ourselves whether or not we are satisfied with the results obtained in terms of reduced morbidity and mortality, whether these results ar e the direct consequence of these measures and whether or not we can d o even better. The present work reviews some of the most recent compar ative reports on the epidemiology of cardiovascular diseases in differ ent populations, and some intervention trials to answer these question s and to help in identifying the most cost-effective approach to cardi ovascular disease prevention in the next few years.