Mancia Giuseppe, Parati Gianfranco, Borghi Claudio, Ghironzi Giuseppe, Andriani Egidio, Marinelli Liano, Valentini Mariaconsuelo, Tessari Francesco, Ambrosioni Ettore
Clinica Medica and Department Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università di Milano-Bicocca, Italy.
J Hypertens. 2006 May;24(5):837-43. doi: 10.1097/01.hjh.0000222752.67572.61.
The aim of the SMOOTH (San Marino Observational Outlooking Trial on Hypertension) study was to explore hypertension awareness, treatment and control and the associated metabolic abnormalities and risk factors in the population of San Marino, a small state in the Mediterranean area, for which limited evidence is available.
Nine general practitioners enrolled 4590 consecutive subjects (44% of the San Marino population age 40-75 years), seen in their office by collecting history, physical and laboratory data and office blood pressure (BP) measurements.
Of these subjects, 2446 were normotensive and 2144 hypertensive; 62.3% of hypertensive patients were aware of their condition, 58.6% were treated (monotherapy 31.5%, combination therapy 27.1%), and 21.7% were controlled. Hypertension awareness and treatment were more frequent above age 50 and in females; BP control was similarly low in both genders. As compared to normotensives, hypertensive subjects were less frequently smokers (20.1 versus 27.8%), had greater body mass index (28.1 +/- 4.5 versus 25.8 +/- 3.7 g/m), and a higher prevalence of diabetes mellitus (15.8 versus 6.3%), lower high-density lipoprotein (HDL) cholesterol and higher prevalence of increased blood total cholesterol (66.1 versus 51.3%), triglycerides and serum uric acid. Values of subjects with 'high-normal' blood pressure were closer to those of hypertensive subjects. The prevalence of metabolic syndrome was higher in hypertensive than in normotensive subjects, and in treated than in untreated hypertensives.
Even in a small Mediterranean country with high health-care standards, hypertension awareness, treatment and control are inadequate and hypertension clusters with metabolic abnormalities and risk factors as in non-Mediterranean areas.
SMOOTH（圣马力诺高血压观察性前瞻性试验）研究的目的是探索地中海地区小国圣马力诺人群中的高血压知晓率、治疗率和控制率，以及相关的代谢异常和危险因素，目前关于该地区的证据有限。
9名全科医生连续纳入了4590名受试者（占圣马力诺40 - 75岁人群的44%），通过收集病史、体格检查、实验室数据以及诊室血压测量在其诊所进行检查。
这些受试者中，2446人为血压正常者，2144人为高血压患者；62.3%的高血压患者知晓自己的病情，58.6%接受了治疗（单药治疗占31.5%，联合治疗占27.1%），21.7%得到了控制。高血压知晓率和治疗率在50岁以上人群及女性中更高；血压控制率在男女中同样较低。与血压正常者相比，高血压患者吸烟的比例更低（20.1%对27.8%），体重指数更高（28.1±4.5对25.8±3.7 g/m），糖尿病患病率更高（15.8%对6.3%），高密度脂蛋白（HDL）胆固醇更低，总胆固醇升高、甘油三酯和血清尿酸的患病率更高。血压“正常高值”受试者的值更接近高血压受试者。高血压患者中代谢综合征的患病率高于血压正常者，接受治疗的高血压患者高于未接受治疗的高血压患者。
即使在一个医疗保健标准较高的地中海小国，高血压的知晓率、治疗率和控制率仍不足，并且高血压与代谢异常和危险因素聚集，与非地中海地区情况相同。
