Presenter: R. Diaz | see Discussant report
Discussant: Georg Ertl | see Presenter abstract
Today a subanalysis was presented on hypertension in the Prospective Urban Rural Epidemiology (PURE) study
The Prospective Urban Rural Epidemiology (PURE) has some unique features:
• It is a very large community based cohort study on 153,996 individuals.
• It very international including 5 continents, 17 countries, 41 centres and 628 communities.
• It offers a wide spectrum of socio-cultural background and medical care including high, middle, and low income countries, and individuals from rural and urban areas.
PURE has some minor limitations:
• The diagnosis of hypertension relies on two blood pressure measurements or self-reporting which carries some risk of false judgment. However, the large number of individuals included in the study may well balance this uncertainty.
• The definition of pre-hypertension: 120-139/80-89 may include many patients with “normal” blood pressure.
• The effect of different health care systems vs. the economic status remains unknown.
• Biological effects of ethnicities remain unclear (see Zimbabwe vs. Asian low income countries).
The major results of the study were:
• Hypertension (and other cardiovascular risk factors) represent a global epidemic
• Globally, awareness, treatment and control of HT is low.
• In rural communities in lower income countries HT control is virtually absent.
• So far, we have focused in rural communities in lower income countries mostly on infectious diseases. However, these communities require specific care also for non-communicable disease and risk factors.
• Transition from a low to a medium income country appears to broaden the complexity and spectrum of heart disease.
• Lessons learned from CVRC in high income countries may help in low income countries.
Conclusions for further development of research and patient care
• The diseases of high income countries become more and more important in low income countries.
• On the other hand, diseases so far rare and therefore not sufficiently studied in high income countries may become more frequent in high income countries along with globalization of disease.
• The study of such diseases in low income countries may improve patient care in high income countries.