Huy Van Tran MD PhD 1


Background: Although, there is a progressive decline in cardiovascular mortality in North America, West Europe, Japan and Australasia, but most hypertensive subjects have imperfect control. In addition, the prevalence of hypertension in Vietnam as well as in developing countries is notable increasing along with the total numbers of strokes and coronary heart disease (CHD) events

Objective: The aim of this study is to determine the cardiovascular risk factors associated with hypertension and the application of the new WHO/ISH guidelines on clinical practice at Khanh Hoa Province, Vietnam.

Subjects and Methods: Cross-sectional study, 258 hypertensive patients with age older than 60 (140 males and 118 females, mean age: 70.377.69) were defined according to the 1999 WHO/ISH criteria. Blood pressure was measured on the right arm with a mercury sphygmomanometer by a physician or a trained nurse. All subjects were evaluated their risk factors by a comprehensive clinical history and full clinical examination. An electrocardiogram at rest and blood samples were obtained after an overnight fast and analyzed for total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, glycemie, and creatinine. In case of total cholesterol >2g/l, HDL-C > 35mg/dl, LDL-C >130mg/dl and glycemia >126mg/dl, a second blood sample was taken to define for the hypercholesterolemia and diabetes mellitus. Assessment of risk level is calculated according to the criteria of 1999 WHO/ISH guidelines.

Results: The prevalence of isolated systolic hypertension was 36.04 per cent. The mean summation of major risk factors per individual was 1.5 0.82 with 1.89 0.81 (male) and 1.05 0.58 (female) P<0.001. The results of additional risk factors were as followed: Hypercholesteroemia 49.41%. (10.89% >2.5g/l). Smoking: 29.45%. Diabetes mellitus: 21.17 %. Family history of premature cardiovascular disease (CVD): 5.81 %. HDL-C < 35mg/dl: 51.51 %. LDL -C >130mg/dl: 46.66 %. Obesity: 1.62 %. Overweight: 12.60 %. Left ventricular hypertrophy: 18.29 %. Microalbuminuria / diabetes 25.92 %. Cerebrovascular disease: 10.07 %. Heart disease: 11.62 %. Renal disease: 3.48 %. Hypertension with grade 1: 35.82 %, grade 2: 42.63 %, grade 3: 20.54 %. Compared with the number of risk factors in the International Nifedipine GITS Study: Intervention as a Goal in Hypertension Treatment (INSIGHT) and the Antihypertensive Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), there was no significant difference. The rate of stratifying risk to quantify prognosis (of the typical 10-year risk of stroke or myocardial infarction) with "Low- risk": 2.32 per cent, "Medium- risk": 39.62 %, "High- risk": 25.96 %, " Very- high-risk": 41.08 %. The application of the current guidelines by local medical practitioners was still very modest.

Conclusion: Cardiovascular risk assessment is an important addition to the doctor's diagnostic and prognostic black bag. However, this study showed that there was little evidence that the clinical practice has improved following release of guidelines. The guidelines were widely acknowledged but largely ignored. Therefore, we need to have univesary guideline and the strategies to apply better theses guidelines for management of hypertension as well as of other risk factors in clinical practice with optimal treatment to improve the quality of life of patient: live longer, live healthier, live happier.

Key words: cardiovascular, coronary heart disease, isolated systolic hypertension

1 Department of cardiology and geriatrics. Khanh Hoa Hospital Vietnam. President, Khanh hoa Heart Association. Correspondence: Huy Tran Van. Presented at 2002 World Congress of Cardiology in Sydney Australia reference No. 2941 ACC. USA