INTRODUCTION

The second haft of the twentieth century saw a progressive decline in cardiovascular mortality in North America, West Europe, Japan and Australia^1-2. However, the percentage of persons in whom hypertension was controlled (defined as a systolic blood pressure (SBP) of less than 140 mmHg and a diastolic blood pressure (DBP) of less than 90 mmHg) is widely viewed as unsatisfactory. The rate of uncontrolled high blood pressure in the United States, Canada, England and France was 27%, 16%, 6% and 24% respectively. For the countries such as Finland, Australia, Germany, Scotland and India (which the criteria of controlled hypertension are defined as a systolic blood pressure of less than 160 mmHg and a diastolic blood pressure of less than 95 mmHg) these proportions were 20.5%, 20%, 19%, 22.5%, 17% and 9 % respectively^3-4. However, the prevalence of hypertension in Vietnam as well as in developing countries is notably increasing along with the incidence of strokes and coronary heart disease (CVD) events^1-7. The prevalence of hypertension in the Asia-Pacific region was from 11% to about 35%⁶. Some of these differences are probably attributable to differences in methodology, demographic composition and socio-economic circumstances^5-6. In Vietnam, a national epidemiology study of hypertension by the Vietnam National Heart Institute was carried out in 1990. The results showed the prevalence of hypertension was 11% (BP=140/90mmHg)⁷ and the prevalence in Khanh Hoa province was 9%⁸. For the city of Hanoi itself, the prevalence of hypertension was 16.09%⁹ in 1996, 18.69% in 2000 was and 23%¹⁰ in 2002. In Thailand, a second national survey was carried out in 1996 and showed a prevalence of 11.6%. The result of Bangkok city was 13,4% (1996) and 23% in the 2000 survey ¹¹. In South Korea, the prevalence of hypertension (BP=140/90mmHg) in males and females was 22% and 23% (1990), 31% and 27% in 1998¹² respectively. In the recent years, the new wave guidelines for the management of individual risk factors were released (Table1). However, nobody have a clear view about the effectiveness of these guidelines on how physicians at the front line practice. In order to give a partial answer to the above problem, we conducted a study with the goals of (1) determining the coexisting cardiovascular risk factors with hypertension according to the new WHO/ISH criteria, and (2) to assess the application of these guidelines in clinical practice by local physicians at Khanh Hoa Hospital, Vietnam.

Table 1: Guidelines released by Cardiovascular Societies

1. The third Adult Treatment Panel ATP III of the National Cholesterol Education Program NCEP May/2001)^{13 14},
2. The American Diabetes Association ADA 2001 Clinical Practice Recommendation Diabetes Care¹⁵,
3. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High blood Pressure (JNC VI 1997)¹⁶,
4. The Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention (ESCP II 1998)¹⁷,
5. The Guidelines for management of hypertension: report of the third working party of the British Hypertension Society (BHS III 1999)¹⁸,
6. The 2000 Canadian Recommendations for the Management of Hypertension (CANADA 2000)¹⁹,
7. The World Health Organization-International Society of Hypertension (WHO/ISH) Guidelines for the Management of Hypertension (WHO-ISH 1999)¹,
8. The Assessment of Cardiovascular Risk by Use of Multiple-Risk-Factor Assessment Equations American Heart Association/American College of Cardiology (AHA/ACC) Scientific Statement 1999²⁰,
9. The AHA/ACC Guidelines for Prevention Heart attack and death in Patients with Atherosclerotic Cardiovascular disease: 2001 Update²¹etc...