Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
PLoS One. 2012;7(6):e39877. doi: 10.1371/journal.pone.0039877. Epub 2012 Jun 27.
There are no time trends in prevalence, unawareness, treatment, and control of hypertension in Switzerland. The objective of this study was to analyze these trends and to determine the associated factors.
METHODS/FINDINGS: Population-based study conducted in the Canton of Geneva, Switzerland, between 1999 and 2009. Blood pressure was measured thrice using a standard protocol. Hypertension was defined as mean systolic or diastolic blood pressure ≥ 140/90 mmHg or self-reported hypertension or anti-hypertensive medication. Unawareness, untreated and uncontrolled hypertension was determined by questionnaires/blood pressure measurements. Yearly age-standardized prevalences and adjusted associations for the 1999-2003 and 2004-2009 survey periods were reported. The 10-year survey included 9,215 participants aged 35 to 74 years. Hypertension remained stable (34.4%). Hypertension unawareness decreased from 35.9% to 17.7% (P<0.001). The decrease in hypertension unawareness was not paralleled by a concomitant absolute increase in hypertension treatment, which remained low (38.2%). A larger proportion of all hypertensive participants were aware but not treated in 2004-2009 (43.7%) compared to 1999-2003 (33.1%). Uncontrolled hypertension improved from 62.2% to 40.6% between 1999 and 2009 (P = 0.02). In 1999-2003 period, factors associated with hypertension unawareness were current smoking (OR = 1.27, 95%CI, 1.02-1.59), male gender (OR = 1.56, 1.27-1.92), hypercholesterolemia (OR = 1.31, 1.20-1.44), and older age (OR 65-74 yrs vs 35-49 yrs = 1.56, 1.21-2.02). In 1999-2003 and 2004-2009, obesity and diabetes were negatively associated with hypertension unawareness, high education was associated with untreated hypertension (OR = 1.45, 1.12-1.88 and 1.42, 1.02-1.99, respectively), and male gender with uncontrolled hypertension (OR = 1.49, 1.03-2.17 and 1.65, 1.08-2.50, respectively). Sedentarity was associated with higher risk of hypertension and uncontrolled hypertension in 1999-2003.
Hypertension prevalence remained stable since 1999 in the canton of Geneva. Although hypertension unawareness substantially decreased, more than half of hypertensive subjects still remained untreated or uncontrolled in 2004-2009. This study identified determinants that should guide interventions aimed at improving hypertension treatment and control.
瑞士在高血压的患病率、知晓率、治疗率和控制率方面均没有呈现时间趋势。本研究的目的是分析这些趋势，并确定相关因素。
方法/发现：本研究是在瑞士日内瓦州进行的一项基于人群的研究，时间跨度为 1999 年至 2009 年。采用标准方案三次测量血压。高血压定义为平均收缩压或舒张压≥140/90mmHg，或自我报告高血压或抗高血压药物治疗。通过问卷调查/血压测量确定高血压的知晓率、未治疗和未控制情况。报告了 1999-2003 年和 2004-2009 年调查期间的年龄标准化患病率和调整后的关联。该 10 年调查共纳入了 9215 名年龄在 35 至 74 岁的参与者。高血压的患病率保持稳定（34.4%）。高血压的知晓率从 35.9%降至 17.7%（P<0.001）。高血压知晓率的下降并没有伴随着高血压治疗的绝对增加，治疗率仍然很低（38.2%）。在 2004-2009 年，与 1999-2003 年相比，所有高血压患者中更多的人虽已知晓但未接受治疗（43.7%比 33.1%）。1999 年至 2009 年期间，未控制的高血压从 62.2%改善至 40.6%（P=0.02）。在 1999-2003 年期间，与高血压知晓率相关的因素包括当前吸烟（OR=1.27，95%CI，1.02-1.59）、男性（OR=1.56，1.27-1.92）、高胆固醇血症（OR=1.31，1.20-1.44）和年龄较大（65-74 岁比 35-49 岁的 OR=1.56，1.21-2.02）。在 1999-2003 年和 2004-2009 年，肥胖和糖尿病与高血压知晓率呈负相关，高教育程度与未治疗的高血压相关（OR=1.45，1.12-1.88 和 1.42，1.02-1.99），而男性与未控制的高血压相关（OR=1.49，1.03-2.17 和 1.65，1.08-2.50）。1999-2003 年，久坐行为与高血压和未控制的高血压风险增加相关。
自 1999 年以来，日内瓦州的高血压患病率保持稳定。尽管高血压的知晓率大幅下降，但在 2004-2009 年，仍有超过一半的高血压患者未接受治疗或控制不佳。本研究确定了一些决定因素，这些因素应指导旨在改善高血压治疗和控制的干预措施。
