Hypertension: A worrying European scenario

November 11, 2008

Results from the European study IMMIDIET, published today in the Journal of Hypertension, official journal of the European Society of Hypertension and International Society of Hypertension, confirm that elevated blood pressure, an important risk factor for cardiovascular disease, is still a looming problem in Europe. Many hypertensive Europeans do not know about their condition, so they are not taking action against it. Even among those who have been diagnosed, more than half have their blood pressure not under optimal control.

The IMMIDIET study examined 1,604 citizens from three geographical areas: south-west London in England, Limburg in Belgium and Abruzzo in Italy. Thanks to a close cooperation with General Practitioners of these areas, all participants underwent a comprehensive medical examination, including blood pressure measurement, and answered a questionnaire about their lifestyle and perception of health status.

Overall, 24% of the population appeared to be hypertensive. "We found - says Simona Costanzo, leading author of the study, from the Research Laboratories at Catholic University of Campobasso - that awareness was far from optimal. A significant proportion of patients (56%) did not know they had high blood pressure". However, awareness is only one side of the coin. Even when people know about their condition, and are under treatment, things do not go so well. Only less than half of diagnosed patients, according to the IMMIDIET results, have their blood pressure falling within desired internationally recognized levels.

Then researchers looked at differences between the three regions, and some surprises arose. In the past, it was accepted that the risk of cardiovascular disease was higher in northern than in southern Europe. It was the so-called "gradient". IMMIDIET showed that this picture is changing. Average blood pressure in English people was lower than in Belgians and Italians. When we consider that also smoking showed the same trend, we could argue that the more we go south, the higher the cardiovascular risk. "It is something like turning upside down the old gradient" Simona Costanzo comments.

"This inversion is surprising, - says Licia Iacoviello, head of the Genetics and Environmental Epidemiology Laboratory at the Catholic University of Campobasso and Coordinator of the IMMIDIET study - 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. On the contrary, in Italy traditional habits are being lost, and we may be observing the negative effects on health".

European women appeared to do better than men. In all three areas studied, they were more aware of hypertension than men and, when on treatment, they tended to have lower blood pressure levels, a sign of a better management of the condition. According to the European team of Authors, this could be related, in part, to the fact that women have more frequent contacts with healthcare practitioners.

"Looking at these data and at other studies conducted in recent years - Licia Iacoviello says - we fear Europe is facing a dangerous situation. Hypertension is a critical causative factor for serious diseases like myocardial infarction (heart attacks) 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".

"All National healthcare systems - says Francesco Cappuccio, Cephalon Chair of Cardiovascular Medicine & Epidemiology at the University of Warwick Medical School, UK, and member of the IMMIDIET study - 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. 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".
-end-
The IMMIDIET study

Funded by the European Union under Key Action 1: Food, Nutrition and Health QLK1-CT-2000-00100, IMMIDIET aims to acquire fundamental knowledge in the field of cardiovascular disease, especially regarding the interaction between genetics and lifestyle.

At the core of the study there is an important episode of Italian migration: Belgium, a country that became the new home for thousand of Italians, mostly from the Abruzzo region, who came to work in the mines. Many of those emigrants didn't come back to Italy but remained in their new country. Some of them married a Belgian. Their genes remained the same, of course, but how much "Italy" is still there in their diet? And how much did they transmit it to their spouses? Moreover, how much Italian emigrants assimilate dietary habits of the country in which they were guests? In this framework, the role of genetic factors and lifestyle can be assessed to explore new ways in prevention of cardiovascular diseases.

To carry on the research, married couples have been recruited in three European areas: South-East London in England, Limburg in Belgium and Abruzzo in Italy. In the first phase of the study, whose data have been used for the research on hypertension, the couples involved were formed by people from the same area, Italians married with Italians (in the Abruzzo region), Belgians married with Belgians (in the Limburg area) and English married with English (in the South-East part of London)".

The second phase of IMMIDIET recruited mixed Italian-Belgian couples to understand if, acquiring dietary habits from Abruzzo, the Belgian partner changed its own risk regarding hearth diseases.

IMMIDIET PARTNERS

Scientific coordinator:

Licia Iacoviello
Laboratory of Genetic and Environmental Epidemiology, Research Laboratories, "John Paul II" Center for High Technology Research and Education in Biomedical Sciences,
Catholic University, Campobasso - Italy

Participants:

Jozef Arnout
Center for Molecular and Vascular Biology, Katholieke Universiteit, Leuven - Belgium

Frank Buntinx
Department of General Practice, Katholieke Universiteit, Leuven - Belgium

Francesco P. Cappuccio
Clinical Sciences Research Institute, University of Warwick Medical School, Coventry - United Kingdom

Pieter C. Dagnelie
Department of Epidemiology, NUTRIM Subdivision of Nutritional Epidemiology, Maastricht University - The Netherlands

Michel de Lorgeril
Nutrition Vieillissement et Maladies Cardiovasculaires, UFR de Medecine, La Tronche - France

Vittorio Krogh
Nutritional Epidemiology Unit, National Cancer Institute, Milan - Italy

Alfonso Siani
Unit of Epidemiology and Population Genetics, Institute of Food Sciences CNR, Avellino - Italy

Catholic University - Campobasso

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