Community-based cardiovascular disease prevention programmes and cardiovascular risk factors: a systematic review and meta-analysis.

OBJECTIVES: This study aimed to summarise the effect of community-based intervention programmes on the prevention of cardiovascular disease (CVD) by reducing cardiometabolic risk factors. STUDY DESIGN: This was a systematic review and meta-analysis. METHODS: A systematic search in the PubMed database and screening of reference lists aimed to identify community-based CVD prevention programmes from inception up to April 2020. The mean differences and standard deviations for CVD risk factors, including blood pressure, lipid profile, blood glucose and body weight indices, were extracted and pooled using a random effects model. RESULTS: Screening of 11,889 titles/abstracts and full texts resulted in 48 studies being included in this review. The meta-analysis showed that community-based programmes have led to considerable decreases in systolic blood pressure (weighted mean difference [WMD] = -2.90 mm Hg, 95% confidence interval [95% CI]: -3.63, -2.16), diastolic blood pressure (WMD = -2.21 mm Hg, 95% CI: -3.12, -1.29), serum levels of low-density lipoprotein cholesterol (LDL-C; WMD = -8.88 mg/dl, 95% CI: -12.84, -4.92), triglycerides (WMD = -8.40 mg/dl, 95% CI: -12.10, -4.70), total cholesterol (WMD = -2.96 mg/dl, 95% CI: -3.10, -2.81) and fasting blood glucose (WMD = -2.06 mg/dl, 95% CI: -3.02, -1.10). A moderate decrease in body weight was also found with community-based CVD prevention programmes. However, community-based CVD prevention programmes were not associated with any significant changes in serum levels of high-density lipoprotein. CONCLUSIONS: The present study indicates that community-based strategies have successfully led to an improvement in CVD risk factors, particularly by reducing blood pressure, serum levels of LDL-C and triglycerides, obesity indices and blood glucose. The impact of these programmes on CVD is modified by the type of intervention and by different cultural and physical environments.

Effect of national recommendations on the sale of sweet products in the upper level of Finnish comprehensive schools.

INTERVENTIONS: In 2007, the Finnish National Board of Education (FNBE) and the National Public Health Institute (KTL) recommended to schools that they quit regular selling of candies and soft drinks. OBJECTIVE: The aim of this study was to determine how and why such selling changed from 2007 to 2008 after the national recommendation. METHODS: Surveys were conducted using online questionnaires to all upper comprehensive schools in Finland. In 2007, 480 (49%) and in 2008, 507 (51%) schools answered the questionnaire; 319 (32%) schools participated in both studies. Schools were asked whether they sold candies, soft drinks or other sweet products and, if theyhad changed the selling of these products, why. The changes in selling were analyzed by using McNemar's test. RESULTS: Of the responding schools, 56% (n=267) and 46% (n=233) sold sweet products in 2007 and 2008, respectively. Of the schools responding both years, 56% reported selling sweet products in 2007 and 50% in 2008. Selling had decreased by 11% among the schools that took part in both studies. The main reasons stated for quitting selling these products were concern about pupils' health (40%) and the recommendation of the FNBE and KTL (38%). CONCLUSIONS: The national recommendation was followed by some decrease in sale of sweet products. For further progress, new actions, both policy measures and broader public involvement, may be needed.

Are we really active in the prevention of obesity and type 2 diabetes at the community level?

The prevalence of type 2 diabetes is increasing rapidly worldwide. Much of this increase in type 2 diabetes epidemic is related to the increase in obesity. There is now firm evidence from randomised trials that type 2 diabetes is preventable by lifestyle modification influencing diet, physical activity and obesity. This prevention effect is sustainable for many years after cessation of active intervention. The slow progression in the development and implementation of population-based strategies in the prevention of obesity and its most common and serious co-morbidity, type 2 diabetes, is of great concern. We summarise published implementation programmes and describe briefly the activities carried out in Finland. In the Finnish implementation programme for the prevention of type 2 diabetes (FIN-D2D), it was found that it is possible to prevent type 2 diabetes "in real life" in the primary health-care settings. We point out that innovative strategic guidelines and their proper implementation are needed to prevent the diabetes epidemic. Among the different tools, also taxation and other regulation to promote healthy food selection and good interaction with the media should be considered.

Transscleral red laser cyclophotocoagulation for the treatment of therapy-resistant inflammatory glaucoma.

PURPOSE: To evaluate in a retrospective study the long-term usefulness of red 647 nm krypton and 670 nm diode laser for transscleral contact cyclophotocoagulation (CPC) in the treatment of therapy-resistant inflammatory glaucoma. METHODS: The authors treated 48 eyes of 38 consecutive patients (mean age 36.8 years, range 6-81 years) with therapy-resistant inflammatory glaucoma secondary to chronic uveitis (45/48), chronic scleritis (1/48), or combined scleritis with keratouveitis (2/48) using transscleral red 647 nm Krypton or 670 nm Diode laser. All eyes had failed maximum tolerated medical therapy and 19/48 (40%) eyes also previous antiglaucoma surgery. Laser power at the scleral surface was 0.35 to 0.45 W and the application time 10 seconds each. The follow-up was 42.8+/- 40.0 (range 2-145) months. RESULTS: The mean preoperative intraocular pressure (IOP) of 35.6+/-8.1 mmHg fell to 6-21 mmHg level in 75% after one or repeated CPC. Among adult patients this was achieved in 85%, among children in 54%. More than one treatment was needed in 52%. No cases of hypotony, phthisis bulbi, or other devastating complications occurred. CONCLUSIONS: Transscleral CPC using red 647 nm krypton or 670 nm diode laser is an effective and well-tolerated procedure for the treatment of therapy-resistant inflammatory glaucoma in adults. CPC can be considered before incisional antiglaucoma surgery with a shunt or antimetabolites is undertaken.

Metabolic epidemiology of colon cancer: effect of dietary fiber on fecal mutagens and bile acids in healthy subjects.

Because of potential significance of fecal mutagens and secondary bile acids in the pathogenesis of colonic cancer and of inverse association between dietary fiber and colonic cancer risk, the effect of dietary wheat and rye fiber on fecal mutagenic activity and bile acid levels was studied in 15 healthy men and women who were consuming high fat/moderately low fiber diets and excreting high levels of fecal mutagens and bile acids. Each participant provided two 24-h stool specimens and a 3-day diet record while consuming their normal diet (control). All subjects were then asked to consume their normal diet plus 11 g of supplemental fiber per day in the form of whole grain bread for 4 weeks. During the last week of diet intervention, each subject provided two 24-h stool specimens and a 3-day dietary record. Fecal samples collected from both periods were analyzed for bile acids and for mutagens using Salmonella typhimurium strains TA98 and TA100 with and without microsomal activation. The concentration of fecal secondary bile acids was significantly lower during the fiber supplemental period in all subjects. Fiber supplementation also inhibited the fecal mutagenic activity in TA100 and TA98 with and without microsomal activation. Thus, the increased fiber intake in the form of whole wheat and rye bread may reduce the production and/or excretion of fecal mutagens and decrease the concentration of fecal secondary bile acids in humans.

Relationship of socioeconomic status to the incidence and prehospital, 28-day, and 1-year mortality rates of acute coronary events in the FINMONICA myocardial infarction register study.

BACKGROUND: Low socioeconomic status (SES) is associated with increased coronary heart disease mortality rates. There are, however, very little data on the relation of SES to the incidence, recurrence, and prognosis of myocardial infarction (MI) events. METHODS AND RESULTS: The FINMONICA MI Register recorded detailed information on all MI events among men and women aged 35 to 64 years in 3 areas of Finland during the period of 1983 to 1992. We carried out a record linkage of the MI register data with files of Statistics Finland to obtain information on indicators of SES, such as taxable income and education, for each individual who is registered. In the analyses, income was grouped into 3 categories (low, middle, and high), and education was grouped into 2 categories (basic and secondary or higher). Among men with their first MI event (n=6485), the adjusted incidence rate ratios were 1.67 (95% CI 1.57 to 1.78) and 1.84 (95% CI 1.73 to 1.95) in the low- and middle-income categories compared with the high-income category. For 28-day mortality rates, the corresponding rate ratios were 3.18 (95% CI 2.82 to 3.58) and 2.33 (95% CI 2.03 to 2.68). Significant differentials were observed for prehospital mortality rates, and they remained similar up to 1 year after the MI. Findings among the women were consistent with those among the men. CONCLUSIONS: The excess coronary heart disease mortality and morbidity rates among persons with low SES are considerable in Finland. To bring the mortality rates of low- and middle-SES groups down to the level of that of the high-SES group constitutes a major public health challenge.

Socioeconomic status and ischemic stroke: The FINMONICA Stroke Register.

BACKGROUND AND PURPOSE: It has been shown that low socioeconomic status is associated with death from stroke. More-detailed data have, however, remained scanty. The purpose of the present study was to examine the association of socioeconomic status with ischemic stroke. Besides mortality, we analyzed the incidence, case-fatality ratio, and prognosis of ischemic stroke events. METHODS: Our population-based study included 6903 first stroke events registered by the FINMONICA Stroke Register in 3 areas of Finland during 1983 to 1992. Indicators of socioeconomic status, such as taxable income and education, were obtained by record linkage of the stroke register data with files of Statistics Finland. RESULTS: Incidence, case-fatality ratio, and mortality rates for ischemic stroke were all inversely related to income. Furthermore, 28 days after the onset of symptoms, a greater proportion of patients with low income than of those with high income was still in institutionalized care and/or in need of help for their activities of daily living. Population-attributable risk of the incidence of first ischemic stroke due to low socioeconomic status was 36% for both sexes. For the death from first ischemic stroke, it was 56% for both sexes. CONCLUSIONS: Persons with low socioeconomic status have considerable excess rates of morbidity and mortality from ischemic stroke in Finland. A reduction in this excess could markedly decrease the burden of ischemic stroke to the society and thus constitute an important public health improvement.

Reduction of blood pressure associated with dietary polyunsaturated fat.

Evidence linking the beneficial effect of dietary polyunsaturated fat on systolic and distolic blood pressure is reported. Under controlled dietary conditions, i.e., when the polyunsaturated fat to saturate fat ratio (P/S) is maintained at about 1.0, with fat providing 25% of total energy intake, blood pressure is significantly lowered in healthy males and females in the 40- to 60-year age group. The subjects selected for these studies were either normotensive or mildly hypertensive. When the subjects resumed their usual diets, their blood pressures reverted to baseline values. Body weights of the subjects remained relatively constant in these studies, and sodium chloride intakes averaged 8 to 12 g per day. It is suggested that the lowering of blood pressure by dietary linoleic acid is mediated through prostaglandins.

North Karelia (Finland) hypertension detection project. Five-year follow-up of hypertensive cohort.

A 5-year follow-up study of a random sample of middle-aged hypertensives indicated that the North Karelia (Finland) Hypertension Detection Project was effective in reducing blood pressure levels. This analysis indicated that the intensification of drug treatment caused marked blood pressure reduction in the community, especially among individuals with previously undetected cases of hypertension. Reduction of blood pressure levels among nontreated persons was observed in this study and may reflect in part the importance of both active case finding and follow-up including health education and preventive services. The community approach used in this study reached and brought under control most of those people who were undetected at the beginning of the study and most of the hypertensives. On the basis of the results, it is concluded that a well-organized hypertension control program can meet the challenge of hypertension care and benefit millions of people throughout the world.

High serum cholesterol and risk of suicide.

OBJECTIVE: The study was conducted to estimate the association between serum total cholesterol concentration and mortality from suicide. METHOD: The baseline serum total cholesterol concentration of 37,635 adults was determined in five independent population surveys conducted during 1972-1992 in Finland. Mortality from different causes of death was monitored for a mean of 14.6 years after the survey dates. The means for violent suicides (N=130) included hanging, firearms, cutting, jumping, and unspecified means. The means for nonviolent suicides (N=46) included drug overdose, poisoning with gases, and drowning. RESULTS: Serum total cholesterol concentration was positively related to the risk of violent suicide. Among subjects whose serum total cholesterol concentration was in the highest category, the adjusted relative risk was more than twofold compared with the lowest category. The violent/nonviolent suicide ratio increased linearly with increasing cholesterol category. No association between serum total cholesterol concentration and the risk of nonviolent suicide was found. CONCLUSIONS: This is the first study to demonstrate the positive relationship of high serum total cholesterol concentration with increased risk of violent suicide.

Inverse correlation between plasma vitamin E and mortality from ischemic heart disease in cross-cultural epidemiology.

Essential antioxidants were determined in plasma of middle-aged men representing 16 European study populations, which differed sixfold in age-specific mortality from ischemic heart disease (IHD). In 12 populations with "common" plasma cholesterol (5.7-6.2 mmol/L) and blood pressure, both classical risk factors lacked significant correlations to IHD mortality, whereas absolute levels of vitamin E (alpha-tocopherol) showed a strong inverse correlation (r2 = 0.63, P = 0.002). Evaluating all populations, cholesterol and diastolic blood pressure were moderately associated, but their correlation was inferior to that of vitamin E. In stepwise regression and multiple regression analysis, mortality was predictable to 62% by lipid-standardized vitamin E, to 79% by vitamin E and cholesterol, to 83% after inclusion of lipid-standardized vitamin A (retinol), and to 87% by all the above parameters plus blood pressure. Thus, in the present study the cross-cultural differences of IDH mortality are primarily attributable to plasma status of vitamin E, which might have protective functions.

Effect of dietary fat on blood pressure in a rural Finnish population.

Thirty couples living in Liperi, a community of North Karelia, aged 40 to 50 yr participated in a dietary intervention study to assess the influence of dietary fat on blood pressure and other parameters. After a weeklong base-line period the subjects consumed a low fat diet (24% of energy) with a polyunsaturated/saturated fat ratio (P/S) of 1.2 for 6 wk. After this 6-wk intervention period the subjects resumed their normal diets (36% energy from fat, P/S 0.15) for an additional 6-wk period. Body weight remained constant throughout the study and salt intakes were approximately 12 g/day. During the low fat, high P/S period a decrease of 7.5 and 2.8 mm Hg pressure occurred for systolic and diastolic blood pressure from the base-line level. When the normal diet was resumed, systolic and diastolic blood pressures increased by 7.7 and 6.3 mm Hg, respectively, from the levels observed at the end of the intervention period.

Changes in serum enterolactone, genistein, and daidzein in a dietary intervention study in Finland.

Phytoestrogens are plant-derived compounds that may have cancer-protective properties. The purpose of the study was to see how enterolactone, daidzein, and genistein serum concentrations reflect major changes in the diet of Finnish subjects. Phytoestrogen concentrations were measured by time-resolved fluoroimmunoassay after hydrolysis and extraction in samples from 85 middle-aged subjects who were part of a 12-week dietary intervention study carried out in North Karelia, Finland. In the baseline and the switchback periods, the subjects consumed their habitual Finnish diet, which is high in saturated fat and low in polyunsaturated fat and vegetables. During the 12-week intervention period, the proportion of dietary energy derived from fat was reduced from approximately 39% to 23%, and the consumption of vegetables, fruit, and berries was markedly increased. Enterolactone concentrations were measured during the baseline, intervention, and switchback periods. The median concentration of enterolactone rose from 12.2 to 19.5 nmol/l (P = 0.002) during the low-fat, high-vegetable diet. Daidzein and genistein concentrations were very low and did not change during the intervention. At baseline, 65% of the population had a low serum enterolactone concentration of <15 nmol/l. During the intervention period, this proportion fell to 34%. These major differences in serum enterolactone concentrations suggest that enterolactone may be used as a biomarker of a healthy diet containing plenty of vegetables, fruit, and berries.

Plasma apolipoprotein B in middle-aged Finnish men. Evidence for a regional gradient of apo B and lack of negative correlation between apo B and dietary linoleate in hyperapobetalipoproteinemia.

Plasma apolipoprotein B (apo B) concentrations were determined in 178 randomly selected 40-49-year-old men from Eastern and Southwestern Finland and compared with the concentrations of plasma lipids and the fatty acid composition of plasma and adipose tissue determined previously from the same populations. The plasma apo B concentrations ranged from 50 to 209 mg/dl. Although men from the two regions had similar mean concentrations of plasma triglyceride, total cholesterol and high density lipoprotein (HDL)-cholesterol, men from Eastern Finland had significantly higher mean apo B levels (139 +/- 25 mg/dl) and a lower ratio of total cholesterol to apo B (1.85 +/- 0.25) than the Southwestern men (125 +/- 33 mg/dl and 2.05 +/- 0.40, respectively). In the whole population, apo B and total cholesterol had significant negative correlations with the percentages of linoleate in the fatty acids of plasma and adipose tissue, which are known to reflect the quality of dietary fat. As the percentages of linoleate have previously been shown to be lower in the Eastern population, part of the regional difference in apo B is obviously explained by differences in the quality of dietary fat. On the other hand, men (n = 59) who had high plasma apo B (greater than 130 mg/dl) but low density lipoprotein (LDL)-cholesterol within the reference values (less than 5.17 mmol/l) showed no correlation between linoleate and apo B. This suggests that other factors than dietary fat determine the concentration of apo B in this group of men.

Retinol, vitamin D, carotenes and alpha-tocopherol in serum of a moderately hypercholesterolemic population consuming sitostanol ester margarine.

We have shown earlier that sitostanol ester margarine lowers serum cholesterol by inhibiting cholesterol absorption so that, theoretically, there could be interference with the absorption of fat-soluble vitamins. Accordingly, we investigated whether sitostanol ester margarine affects the serum levels of vitamin D, retinol, alpha-tocopherol and alpha- and beta-carotenes during 1-year treatment in 102 subjects and 49 controls with moderate hypercholesterolemia. The vitamins were assayed at baseline on home diet, on margarine alone, after 1 year's consumption of sitostanol ester margarine and after an additional 2 months on home diet. In the sitostanol group, serum plant sterols, indicators of cholesterol absorption efficiency, were reduced up to -38% in relation to controls from home diet (P < 0.01) indicating that cholesterol absorption was markedly reduced. Vitamin D and retinol concentrations and the ratio of alpha-tocopherol to cholesterol were unchanged by sitostanol ester. Serum beta-carotenes and alpha-carotene concentration but not proportion were reduced in the sitostanol group from baseline and in relation to controls (P < 0.01). Retinol and vitamin D were unassociated with serum cholesterol, plant sterols or other vitamins, whereas alpha-tocopherol and carotenes were significantly associated with serum plant sterols suggesting that the higher cholesterol absorption efficiency, the higher the alpha-tocopherol and carotene levels in serum. We conclude that sitostanol ester did not affect vitamin D and retinol concentrations and alpha-tocopherol/cholesterol proportion, but reduced serum beta-carotene levels. Alpha-tocopherol and carotenes, but not vitamin D and retinol, were related to serum cholesterol and cholesterol absorption.

Long-term cost and life-expectancy consequences of hypertension.

OBJECTIVE: To estimate hypertension's long-term cost and impact on life expectancy. DESIGN: A 19-year individual follow-up study. Subjects were categorized according to their baseline (1972) diastolic blood pressure (DBP) level into three groups: normotensive (DBP < 95 mmHg), mildly hypertensive (DBP 95-104 mmHg), and severely hypertensive (DBP > 104 mmHg). By using their social security identification numbers, we linked the subjects to a set of national registers covering hospital admissions, use of major drugs, absence due to sickness, disability pensions, and deaths. SUBJECTS: A random population sample of 10 284 men and women aged 25-59 years from the provinces of Kuopio and North Karelia in eastern Finland. MAIN OUTCOME MEASURES: The numbers of years of life and years of work lost, the cost of drugs and hospitalization, and the value of productivity lost due to disability and premature mortality. RESULTS: The difference in life expectancy between normotensive and severely hypertensive men was 2.7 years, of which 2.0 years was due to cardiovascular disease (CVD). Among women the corresponding differences were 2.0 and 1.5 years. Severely hypertensive men lost 2.6 years of work more than did normotensive men, of which 1.7 years was due to CVD. Among women the differences were 2.2 and 1.3 years. The mean undiscounted total costs (USA dollars at 1992 prices) were $132 500 among normotensive, $146 500 among mildly hypertensive, and $219 300 among severely hypertensive men, of which CVD accounted for 28, 39, and 43%, respectively. More than 90% of the total costs were indirect productivity losses. Among women the total costs were lower for all DBP categories, as were the shares of CVD-related costs. The proportional increase in costs on going from the lowest to the highest DBP category was, however, somewhat larger among women. CONCLUSIONS: On the population level, severe hypertension leads to considerable losses in terms of years of life lost, years of work lost, and costs. However, the overall impact of mild hypertension is much more limited.

The development of hypertension care in Finland from 1982 to 1987.

The development of hypertension care in Finland was evaluated using the data from two independent population samples of the FINMONICA Project comprising 9350 and 6250 persons examined in 1982 and 1987, respectively. The sampling frame was the population aged 25 to 64 years in the provinces of North Karelia and Kuopio in eastern Finland and in the Turku-Loimaa region in south-western Finland. During the 5-year period, the mean systolic blood pressure levels decreased in all of the groups except the North Karelian men. Mean diastolic blood pressure did not change significantly. The proportion of hypertensive men with adequately controlled blood pressure increased from 22.6 to 29.4% [difference 6.8%, 95% confidence interval (Cl) for the difference 2.4-11.2] during 1982-1987. At the same time, the proportion of hypertensive men unaware of their condition fell from 30 to 20.9% (difference -9.1%, 95% Cl for the difference -13.4- -4.8). There was corresponding falls for women from 39.2 to 41.3% (difference 2.1%, 95% Cl for the difference -3.1-7.3) and from 15.4 to 13.1% (difference -2.3%, 95% Cl for the difference 1.4- -6.0), respectively. Thus, obvious progress had taken place, although the situation remained far from satisfactory. The possibility of overly aggressive treatment of hypertension was also investigated. It was found that only less than 10% of the middle-aged hypertensive men treated with drugs had diastolic pressures less than or equal to 85 mmHg, suggesting that this might not be an issue of concern at community level.

Low diastolic blood pressure and mortality in a population-based cohort of 16913 hypertensive patients in North Karelia, Finland.

OBJECTIVE: To examine the relationship between mortality and diastolic blood pressure during treatment. DESIGN: A prospective follow-up of a population-based dynamic cohort of hypertensive patients. SETTING: Province of North Karelia, eastern Finland. PATIENTS: A cohort of 16 913 North Karelian hypertensive patients in hypertension register of the North Karelia Project, who had been followed up since 1972 until the end of 1985. Most of these patients had been under antihypertensive drug therapy during the follow-up. MAIN OUTCOME MEASURES: Death: all deaths (n = 4490), deaths from cardiovascular disease (n = 2995) and deaths from non-cardiovascular disease (n = 1495). RESULTS: Of all deaths, 17% of those among men and 24% of those among women were of patients with mean diastolic blood pressures less than 90 mmHg. We found a U-shaped relationship between diastolic blood pressure and total, cardiovascular and non-cardiovascular mortalities. We investigated this relationship in more detail using Cox regression model. Low diastolic blood pressure was associated independently with increased mortality for the patients aged 50 years or more at baseline. The occurrence of cardiac failure and other cardiovascular complications of hypertension were more important determinants of mortality than was low diastolic blood pressure alone. CONCLUSIONS: We demonstrated that there is an association between low diastolic blood pressure and mortality for treated hypertensive patients aged 50-69 years. The clinical importance of this relationship for patients without any cardiovascular complications of hypertension seems negligible. For patients with complications, these complications are likely to be primary factors causing greater than normal mortality and low diastolic blood pressure is mostly a secondary phenomenon. Our data do not lend support to speculations that there is overtreatment of hypertension, which would increase mortality through making diastolic blood pressures too low.

Blood pressure levels and obesity trends in hypertensive and normotensive Finnish population from 1982 to 1997.

OBJECTIVE: To assess the trends in blood pressure (BP) and in body mass index (BMI) in the hypertensive and normotensive population in Finland during 1982-1997. DESIGN: Four independent cross-sectional standardized population surveys were conducted in 1982, 1987, 1992 and 1997. SETTING: The provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in southwestern Finland. PARTICIPANTS: Men and women aged 25-64 years were selected randomly from the national population register. The participants were classified into four groups according to their BP level and treatment status: normotensive, unaware hypertensive, aware but untreated hypertensive and treated hypertensive. The total number of participants was 24,083. MAIN OUTCOME MEASURES: The means of systolic BP (SBP), diastolic BP (DBP) and BMI, as well as the distribution of BMI among the four study groups were measured. RESULTS: Mean SBP decreased significantly in all groups. The fall in DBP was significant only in drug-treated hypertensive men and women (P< 0.001). Mean BMI increased significantly in all groups except in aware hypertensive women receiving no antihypertensive drug treatment The proportion of obese subjects (BMI > 30 kg/ m2) increased most in aware hypertensive men and in drug-treated hypertensive women. CONCLUSIONS: The prevalence of obesity has increased significantly in normotensive and particularly in hypertensive Finns during the past 15 years. There is an urgent need for more effective measures for weight reduction in obese hypertensive patients in primary healthcare, and for the prevention and control of obesity in the whole population.

Trends in blood pressure levels and control of hypertension in Finland from 1982 to 1997.

OBJECTIVE: To assess the trends in blood pressure levels and hypertension control in Finland from 1982 to 1997. DESIGN: Four independent cross-sectional population surveys conducted in 1982, 1987, 1992 and 1997. SETTING: From 1982 to 1997, the provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in southwestern Finland were surveyed. From 1992 to 1997, the Helsinki-Vantaa region in southern Finland was surveyed. PARTICIPANTS: Men and women aged 25-64 years were selected randomly from the national population register. The total number of participants was 27 623. MAIN OUTCOME MEASURES: We assessed mean systolic and diastolic blood pressure, prevalence of hypertension (subjects with systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg or current use of antihypertensive drug treatment) and antihypertensive drug treatment and quality of hypertension care among hypertensive persons. RESULTS: Mean systolic blood pressure and the prevalence of hypertension decreased significantly in all areas except among men in the Helsinki-Vantaa region. The fall in mean diastolic pressure was significant only in eastern Finland. The proportion of hypertensives who were unaware of their condition fell from 45.5 to 24.1% in men and from 27.2 to 15.7% in women. At the same time, the proportion of hypertensives with adequately controlled blood pressure (systolic pressure < 160 mmHg and diastolic pressure < 95 mmHg) increased from 9.4 to 23.5% in men and from 16.0 to 36.7% in women. CONCLUSION: Hypertension care in Finland has improved significantly during the last 15 years. However, the situation is still far from optimal. It is obvious that the biggest problem in hypertension care has shifted from detection to adequate treatment of high blood pressure.