European Journal of Epidemiology

, Volume 16, Issue 3, pp 265–270 | Cite as

Prevalence, awareness, treatment and control of hypertension in a working Bulgarian population

  • Aryeh D. Stein
  • Vassil Stoyanovsky
  • Valentina Mincheva
  • Emil Dimitrov
  • Donka Hodjeva
  • Anton Petkov
  • Veska Tsanova


Arterial hypertension is a major risk factor for coronary heart disease and stroke mortality. Few data exist on prevalence, awareness, and management of hypertension in Bulgaria, precluding development of potentially beneficial risk reduction initiatives. Between September 1996 and July 1997, an age-sex stratified sample of 847 male and 771 female employees (age 18–64 y) of the national transport industry resident in Sofia was recruited during their annual physical examination. A structured interview was conducted and resting blood pressure (BP) measured. Prevalence: Elevated BP (mean of two consecutive readings SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg) was observed among 24% of women and 58% of men (p < 0.001). Prevalence increased with age in both men and women. Awareness: Among 722 employees with elevated BP, 49% of women and 33% of men (p < 0.001) reported history of hypertension. Awareness increased with age. Management: Among 345 employees with history of hypertension, 37% of women and 36% of men (p > 0.05) reported taking antihypertensive treatment. The proportion under management increased with age. Control: Normal BP was measured in only 6% of men and 7% of women taking antihypertensive medication (p > 0.05; no consistent trends by age). Elevated BP is widespread and hypertension is underdiagnosed and poorly controlled in this urban working-age Bulgarian population, especially among those under 40 y. This may contribute to the high rates of coronary heart disease and stroke incidence and mortality in Bulgaria.

Awareness Bulgaria Control Hypertension Prevalence Treatment 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute, National Institutes of Health. NIH Publication No. 98–4080.Google Scholar
  2. 2.
    Pisa Z, Uemura K. Trends of mortality from ischaemic heart disease and other cardiovascular diseases in 27 countries 1968–1977. Wrld Hlth Stat Quart 1982; 35: 11–47.Google Scholar
  3. 3.
    Uemura K, Pisa Z. Trends in cardiovascular disease mortality in industrialized countries since 1950. Wrld Hlth Stat Quart 1988; 41: 155–178.Google Scholar
  4. 4.
    MRC Medical Research Council Working Party: MRC trial of treatment of mild hypertension, principal results. Br Med J 1992; 304: 405–412.Google Scholar
  5. 5.
    SHEP-Systolic Hypertension in the Elderly Program. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results. JAMA 1991; 265: 3255–3264.Google Scholar
  6. 6.
    Staessen J, Fagard R, Thijs L, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997; 350: 757–764.CrossRefPubMedGoogle Scholar
  7. 7.
    STOP Hypertension. Swedish Trial in Older Patients with Hypertension. Morbidity and mortality in the Swedish trial. Lancet. 1991; 338: 1281–1285.Google Scholar
  8. 8.
    Pisa Z, Uemura K. International differences in developing improvements in cardiovascular health. Ann Medicine 1989; 21: 193–197.Google Scholar
  9. 9.
    Sans S, Kesteloot H, Kromhout D. The burden of cardiovascular diseases mortality in Europe. Eur Heart J 1997; 12: 1231–1248.Google Scholar
  10. 10.
    Murray CJL, Lopez AD. Global Health Statistics. Global burden of disease and injury series, volume 2. Boston MA, 1996: Harvard University Press.Google Scholar
  11. 11.
    Burt VL, Whelton P, Rocella EJ, et al. Prevalence of hypertension in the US adult population. Hypertension 1995; 25: 305–313.PubMedGoogle Scholar
  12. 12.
    Ibrahim MM, Rizk H, Appel LJ, et al. Hypertension prevalence, awareness, treatment, and control in Egypt. Results from the Egyptian National Hypertension Project (NHP). Hypertension 1995; 26(part 1): 886–890.PubMedGoogle Scholar
  13. 13.
    Puras A, Sanchis C, Artigao LM, et al. Prevalence, awareness, treatment and control of hypertension in a Spanish population. Eur J Epidemiol 1998; 14: 31–36.PubMedGoogle Scholar
  14. 14.
    Stein AD, Mincheva V, Stoyanovsky V, et al. Prevalence of risk factors for cardiovascular disease in a working Bulgarian population. CVD Prevention 1998; 1: 217–224.Google Scholar
  15. 15.
    National High Blood Pressure Education Program Working Group. National High Blood Pressure Education Program Working Group report on primary prevention of hypertension. Arch Intern Med 1993; 153: 186–208.Google Scholar
  16. 16.
    Stamler J, Stamler R, Neaton JD. Blood pressure, systolic and diastolic, and cardiovascular risks. Arch Intern Med 1993; 153: 598–615.PubMedGoogle Scholar
  17. 17.
    Puska P, Nissinen A, Tuomilehto J, et al. The community-based strategy to prevent coronary heart disease: conclusions from the ten years of the North Karelia project. Ann Rev Public Health 1985; 10: 147–193.Google Scholar
  18. 18.
    Farquhar JW, Fortmann SP, Flora JA, et al. Effects of communitywide education on cardiovascular disease risk factors: The Stanford Five-City Project. JAMA 1990; 264: 359–365.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • Aryeh D. Stein
    • 1
  • Vassil Stoyanovsky
    • 2
  • Valentina Mincheva
    • 2
  • Emil Dimitrov
    • 2
  • Donka Hodjeva
    • 2
  • Anton Petkov
    • 2
  • Veska Tsanova
    • 2
  1. 1.Department of EpidemiologyMichigan State UniversityEast LansingUSA
  2. 2.Department of CardiologyTransport Medical InstituteSofiaBulgaria

Personalised recommendations