An EU-funded population study has shown that hypertension, an important risk factor for cardiovascular disease, is a serious problem in Europe. The results of the IMMIDIET project indicate that high blood pressure has become more common in Italy than in England or Belgium, a reversal of the commonly accepted trend. They also demonstrate that awareness is quite limited, and that those who are diagnosed do not adequately manage their condition. The results have been published online in the Journal of Hypertension.

The IMMIDIET project ('Dietary habit profile in European communities with different risk of myocardial infarction: the impact of migration as a model of gene/environment interaction') was funded by the European Union under the 'Quality of life and management of living resources' Thematic Programme of the Fifth Framework Programme (FP5). The current study was carried out by researchers in Italy, Belgium, the Netherlands, France and the UK.

The IMMIDIET researchers, working closely with general practitioners in southwest London in England, Limburg in Belgium and Abruzzo in Italy, examined 1,604 patients. The patients underwent a comprehensive medical examination that included blood pressure measurement, and were asked to fill in a questionnaire about their lifestyle and perception of health status. They defined 'hypertension' as systolic blood pressure of at least 140mmHg or diastolic blood pressure of at least 90mmHg, or 'current antihypertensive treatment'.

The researchers were mindful of the effects of both genetic and lifestyle factors on cardiovascular disease, and recruited both married couples formed by people from the same area (Italians married with Italians in the Abruzzo region, and so forth) and mixed-nationality couples in different phases of the project.

Their findings showed, surprisingly, that high blood pressure was less common in England than in Belgium or Italy. This regional difference represents a reversal of the so-called north-south 'cardiovascular gradient'.

"This inversion is surprising," said Dr Licia Iacoviello of Italy's Catholic University of Campobasso. "It may reflect the ongoing changes of lifestyle habits. Paradoxically, northern European countries, where cardiovascular risk was higher than in Italy, are now modifying their habits, getting closer to the ancient Italian food and lifestyle culture, thus living a healthier life. [However], in Italy traditional habits are being lost, and we may be observing the negative effects on health."

Overall, the study found that awareness of hypertension was poor: 24% of study participants were hypertensive and 56% of these were unaware of their condition (one third was receiving treatment). Among those who had been diagnosed with high blood pressure, less than half had managed to bring down their blood pressure to acceptable levels.

According to Professor Francesco Cappuccio of the University of Warwick in the UK, "All national healthcare systems should do more to help control hypertension. Although in England the management of high blood pressure is better as compared to some other countries, in part due to the incentives that general practitioners receive to achieve blood pressure targets, we still have too many patients not adequately treated and the incidence of hypertension is rising still."

The IMMIDIET study also found that awareness of cardiovascular disease, hypertension in particular, is higher in women than in men. Also, women were more likely to be under treatment for hypertension, and were more successful in bringing down their blood pressure to internationally accepted 'desirable' levels. The researchers attributed this 'more successful management' to the increased willingness of women to participate in the healthcare system.

Dr Iacoviello warned, "Looking at these data and at other studies conducted in recent years, we fear Europe is facing a dangerous situation. Hypertension is a critical causative factor for serious diseases like heart attack and stroke, but it is still grossly underestimated. So we need urgent and intensive initiatives in this field, introducing new and effective strategies in controlling this threat."

Professor Cappuccio added, "This is a call for an integrated action not only on better management of hypertension but on the implementation of widespread strategies for the prevention of it in the first place."

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