POLAND AND US COLLABORATIVE STUDY ON CARDIOVASCULAR EPIDEMIOLOGY HYPERTENSION IN THE COMMUNITY - PREVALENCE, AWARENESS, TREATMENT, AND CONTROL OF HYPERTENSION IN THE POL-MONICA PROJECT AND THE US ATHEROSCLEROSIS RISK IN COMMUNITIES STUDY

PURPOSE: The objectives of this manuscript are to assess differences i n blood pressure levels and in hypertension prevalence, awareness, tre atment, and. control for selected rural and urban areas in the U.S. an d Poland, where ischemic heart disease mortality trends are different. METHODS: Included are white persons aged 45-64 selected in Minneapoli s, 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 P oland'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 bloo d pressures were > 15% higher for Polish samples than for the U.S. (p < 0.01). In multivariable analysis, hypertension was significantly pos itively related to age and body mass index (BMI) in both U.S. and Poli sh samples (except age in Polish men), and to heart rate in Polish sam ples and U.S. rural women. Smoking was significantly negatively relate d to hypertension in urban Polish and rural U.S. men. Hypertension awa reness, treatment, and control were better in U.S. than in Polish samp les. In the U.S. > 80% of subjects with hypertension (systolic blood p ressure (SBP) greater than or equal to 160 mmHg or diastolic blood pre ssure (DBP) greater than or equal to 95 mmHg or on treatment) were con trolled whereas in Polish samples less than or equal to 17% of hyperte nsive men and 16% of hypertensive women were controlled. When SBP grea ter than or equal to 140 mmHg or DBP greater than or equal to 90 mmHg or on treatment defined hypertension, control was about 55% in U.S. sa mples and about 2% in Polish samples. CONCLUSIONS: Hypertension preval ence is higher and blood pressure levels are less well controlled in P olish than in U.S. samples. These striking differences can be expected to contribute to opposing trends in coronary heart disease (CHD) mort ality 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. (C) 1998 Elsevi er Science Inc.