Türkiye’de kan basıncı düzeylerindeki değişim/Changes in the prevalence of hypertension in Turkey

Abstract

Ozet Amac: Koroner kalp hastaligi icin bilinen degistirilebilir risk etmenlerinden birisi de yuksek kan basincidir. Yuksek kan basinci sikliginin izlenmesi, koroner kalp hastaligi riskinin ve sikliginin belirlenmesi acisindan onemlidir Bu calismada Turkiye’de kan basinci ile ilgili verisi olan toplum tabanli calismalar sistematik olarak incelenmis ve eriskinlerde kan basinci duzeylerinin yillar icindeki degisimi degerlendirilerek gelecek yillar icin cikarimlarda bulunulmasi amaclanmistir. Yontem: Calismada uluslararasi ve ulusal elektronik veritabanlari taranmistir. Medline veritabaninda “blood pressure or hypertension and Turkey” anahtar sozcukleri ile toplam 2073 makaleye ulasilmistir. Bu arastirmalarin 14 tanesinin toplum tabanli oldugu, hipertansiyon prevalansi icerdigi saptanmistir. Ulakbim veritabani taramasinda “hipertansiyon” anahtar sozcugu ile 1184 makaleye ulasilmis ve bunlardan 5 tanesinin toplum tabanli oldugu saptanmistir. Yuksek Ogretim Kurulu tez merkezi veritabani taramasinda “hipertansiyon” anahtar sozcugu ile toplam 933 onaylanmis teze ulasilmis ve 22 tanesinin toplum tabanli oldugu sonucuna varilmistir. Sonuc olarak kan basinci ve hipertansiyon sikligi icin 19 calisma degerlendirmeye alinmistir. Yasa ve cinsiyete gore hipertansiyon sikligi ve ortalamalari verilmis olan ve hipertansiyon tanimi birbirine benzeyen TURDEP 1-2 (1998-2010) ve PATENT (2003) calismalari Turkiye’de yillara gore hipertansiyon sikligindaki degisimi incelemek icin istatistiksel degerlendirmeye alinmistir. Microsoft Excel programinda olusturulan regresyon esitlikleri kullanilarak 2015 yilina kadar olan donemdeki beklenen sikliklar hesaplanmistir. Bulgular: Incelenen calismalarda hipertansiyon sikligi erkeklerde %28.4-%49.0, kadinlarda ise %38.0-%59.0 arasinda degismektedir. 1997-2010 yillari arasinda hipertansiyon sikligi 30 yas uzeri kadinlarda 1997’den 2010 yilina kadar yillik %0.7 oraninda, erkeklerde yillik %0.2 oraninda azalma gostermistir. 1997-2010 yillari arasinda 30 yas uzeri kadinlarda sistolik kan basinci ortalamasi 1997’den 2010 yilina kadar yillik %0.3 oraninda, erkeklerde yillik %0.08 oraninda azalma gostermistir. Sonuc: Turkiye’de hipertansiyon sikliginin kadinlarda daha yuksek oldugu ve azalmanin daha fazla olmasina karsin toplamda sikligin yine erkeklere gore daha yuksek oldugu gorulmektedir. Bu konuda toplanan veri kapsayicilik, siklik bakimindan yetersiz gorulmektedir. Turkiye’de hipertansiyon sikligi ve sistolik kan basinci ortalamalari kadinlarda ve dusuk bir oranda da olsa erkeklerde azalma egilimindedir. Var olan calismalarin sonuclarina gore bu azalma egiliminin kontrol programlari ile hizlanacagi dusunulmektedir. Hipertansiyon sikliginin yillar icindeki degisimini degerlendirmek icin ulusal boyutta, karsilastirilabilir yontemlere dayanan ve belli aralarla tekrarlanan calismalara gereksinim vardir. Anahtar Kelimeler: Yuksek kan basinci sikligi, sistematik derleme, regresyon Abstract Objective: Hypertension is one of the well known risk factors for coronary heart disease. Screening for the prevalence of hypertension is crucial for determining the risks of coronary heart disease and its occurrence. In this study community based surveys that involve information on blood pressure were systematically reviewed, the changes in mean blood pressure levels by years were evaluated and projections for future years were estimated. Methods: International and national electronic databases were screened. A total of 2073 articles were reached by using the keywords “blood pressure or hypertension and Turkey” on the Medline database. Fourteen of these studies were community based and provided information for hypertension prevalence. A search of the ULAKBIM database with the keyword “hypertension” produced 1184 articles and 5 of these were community based. By searching the Council of Higher Education database with keyword “hypertension”, 933 approved theses were found and 22 of them were community based. As a result, 19 studies were evaluated for blood pressure and hypertension prevalence. After a critical appraisal it was decided to use TURDEP 1-2 (1998-2010) and PATENT (2003) surveys for assessing the change in hypertension prevalence by years in a statistical analysis. Using regression coefficients generated by the Microsoft Excel program we calculated the expected prevalence of hypertension up to 2015. Results: Among the studies evaluated, the prevalence of hypertension ranged from 28.4% to 49.0% in men and 38.0% to 59.0% in women. The prevalence of hypertension among women over 30 years old declined annually by 0.7% from 1997 to 2010 and the annual decline rate for men was 0.2%. Mean blood pressure values decreased by 0.3 mmHg annually among women and by 0.08 mmHg among men from 1997 to 2010. Conclusions: The prevalence of hypertension and the mean blood pressure values show a significantly declining trend among women and slightly declining trend among men in Turkey. Based on the findings from the literature it is thought that these decreasing trends will accelerate by hypertension control programs. Periodical nationwide studies using comparable methodologies are needed to evaluate the changes in prevalence of hypertension. Key Words: High blood pressure, systematical review, regression