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Assessing Hypertension Control and Management
Hypertension Management Audit Project: a WHO/WHL Study
edited by T. Strasser and L. Wilhelmsen
WHO Regional Publications, European Series, No. 47
1993, xiv + 181 pages [E]
ISBN 92 890 1310 9
Sw.fr. 39.-/US $35.10; in developing countries: Sw.fr. 27.30
Order no. 1310047
Reports the results of a large research project, the Hypertension Management Audit Project, designed to assess the extent to which hypertension is adequately controlled and managed in different communities. Carried out in seven European countries, the study aimed to identify weaknesses in the detection and management of hypertension and thus guide the development of more effective public health policies. Factors assessed include awareness of hypertension in the general population, the work-up and management of hypertensive patients, patient compliance and satisfaction with the prescribed therapy, the extent to which treated patients have achieved normal blood pressure levels, drugs most frequently prescribed by physicians, and the sources of information that influence physician prescribing practice. The study gave particular attention to the importance of physicians' attitudes and practices, especially concerning non-drug treatment and the management of risk factors.
The book has two parts. The first describes the design, protocol, and objectives of the study, and discusses its major findings. The second and most extensive part consists of fourteen reports of country projects, ranging from a survey of employees at a chemical plant in Hungary to a study of the discrepancies between attitudes and self-reported behaviour among physicians in Germany. The protocol for the research project is reproduced in an annex.
Cardiovascular Disease and Steroid Contraception
Report of a WHO Scientific
Technical Report Series, No. 877
1998, vii + 89 pages [E, F*, S*]
ISBN 92 4 120877 5
Sw.fr. 20.-/US $18.00; in developing countries: Sw.fr. 14.-
Order no. 1100877
Evaluates the strength and significance of evidence linking use of combined oral contraceptives to an increased risk of cardiovascular disease in women. Recommendations and conclusions reflect the consensus reached by a group of scientists, including researchers directly involved in several recent large-scale investigations of cardiovascular disease and hormone contraception. The experts also considered evidence that other factors, such as smoking, hypertension, diabetes, age, and family history, might influence the risk of cardiovascular disease in users of combined oral contraceptives. In view of major recent changes in the hormonal content of these contraceptives and the prescribing patterns of providers, the assessment concentrates on data collected after 1980. The experts also aimed to determine whether the risk of disease is influenced by the estrogen or progestogen content of different preparations.
To facilitate the comparison and interpretation of study results, the report opens with a discussion of the strengths and weaknesses of the different epidemiological approaches used to assess the safety of steroid contraceptives. Also discussed is the important distinction between the use of relative risk to examine epidemiological associations and the use of absolute risk to examine clinical importance. Against this background, the main part of the report examines the strength of evidence linking steroid contraceptives to an increased risk of acute myocardial infarction, ischaemic stroke, haemorrhagic stroke, and venous thromboembolism. Studies of combined oral contraceptives and progestogen-only contraceptives are considered separately for each disease. An effort is also made to determine whether conclusions, based on studies conducted in industrialized countries, are also valid for women living in the developing world.
The assessment of findings from epidemiological studies is complemented by a review of possible biological explanations for the effects of combined oral contraceptives on cardiovascular functions. On the basis of all available evidence, the report concludes that mortality rates from cardiovascular disease are extremely low among women of reproductive age and that the added risk of using steroid contraceptives is also very low in users who do not smoke or have other risk factors for cardiovascular disease. A final section places these risks in perspective and offers balanced advice useful to providers of family planning when helping women to make informed choices about the use of hormonal contraceptives.
Cardiovascular Disease Risk Factors: New Areas for Research
Report of a WHO Scientific Group
Technical Report Series, No. 841
1994, vi + 53 pages [C, E, F, R, S]
ISBN 92 4 120841 4
Sw.fr. 10._/US $9.00; in developing countries: Sw.fr. 7._
Order no. 1100841
Identifies and assesses specific research areas where further investigation promises to yield better knowledge about the risk factors for cardiovascular disease and the most effective strategies for prevention. Addressed to scientists and research administrators, the report concentrates on new strategies for studying a number of established or suspected risks in order to clarify their significance as predictors of disease or factors causally linked to pathogenic mechanisms. The "classical" risk factors, such as high serum cholesterol levels, hypertension, and smoking, are not considered.
The report identifies ten promising new areas for further study. For each, a review of the scientific background is followed by a discussion of implications for prevention and control and precise recommendations for further research. These areas include nutritional factors, such as plant foods and antioxidants, and metabolic factors, including the possible roles of newly identified lipoprotein phenotypes, insulin resistance, and high levels of plasma homocysteine. Haemostatic factors are also considered, with particular attention given to the roles of fibrinogen, coagulation factor VII, platelet number, and fibrinolytic modulators. Other areas include the possible protective roles of alcohol, and especially of wine, and of physical activity.
Special attention is given to the need to study how hormone replacement therapy affects cardiovascular disease in women and to balance its potential benefits against the possible risks of endometrial and breast cancer. Other areas covered include the roles of genetic factors and of social, cultural and psychosocial factors that might explain the marked differences in mortality observed in different groups both within and between countries.
Epidemiology and Prevention of Cardiovascular Diseases in Elderly People
Report of a WHO Study Group
Technical Report Series, No. 853
1995, v + 67 pages [E, F, S*]
ISBN 92 4 120853 8
Sw.fr. 14.-/US $12.60; in developing countries: Sw.fr. 9.80
Order no. 1100853
A state-of-the-art review of what is currently known about the epidemiology of cardiovascular diseases in elderly people and the possibilities for prevention. Noting that little attention has been given to the problem of cardiovascular diseases in this age group, the report aims to highlight opportunities for prevention while also underscoring the medical, social, and economic implications of increased longevity and the corresponding increase in the prevalence of cardiovascular disease. Both population-based approaches to prevention and strategies for reaching high-risk individuals are considered. Areas where knowledge is weak and research is urgently needed are also indicated.
The report has six main sections. The first, on demographic trends, summarizes key characteristics of the elderly population in various parts of the world, discusses the current and projected size of the elderly population, and describes changes in life expectancy over the past four years. A profile of cardiovascular diseases in the elderly is provided in the second section, which includes information on the global burden of cardiovascular diseases, trends in mortality rates and possible explanations, the most important cardiovascular diseases affecting the elderly, and eight principal risk factors. The third and most extensive section reviews health policy options for the prevention of cardiovascular diseases in elderly people and discusses their relative cost-effectiveness. Emphasis is placed on lifestyle approaches and on the medical management of risk factors. The remaining sections discuss opportunities for rehabilitation and establish guidelines for the development of health policies aimed at the prevention of cardiovascular disease in the elderly.
Report of a WHO Expert Committee
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Technical Report Series, No. 862
1996, vi + 83 pages [E, F, S*]
ISBN 92 4 120862 7
Sw.fr. 16.-/US $14.40; in developing countries: Sw.fr. 11.20
Order no. 1100862
A state-of-the-art review of research findings that contribute to an understanding of hypertension and the best measures for its prevention and control _ whether in individual patients or entire populations. Noting that elevated blood pressure is a massive health problem in almost every country, the report argues that programmes for hypertension control should be an integral part of all national health care systems. With this goal in mind, the report aims to help policy makers appreciate the significance and complexities of hypertension, understand the options available for control, and then select the most appropriate mix of interventions. Details range from recommended procedures for obtaining an accurate assessment of blood pressure, through advice on the best drugs for first-line treatment of hypertensive patients, to a discussion of ways to educate populations about relevant lifestyle changes
Throughout the report, population-based and individual approaches are presented as complementary, synergistic strategies for hypertension control. To assist physicians as well as policy makers, the report includes abundant recommendations, based on the best scientific evidence, for the management of different patient groups. A section on the clinical assessment of the hypertensive patient explains the components of a coherent, step-wise diagnostic process involving history taking, physical examination, and laboratory investigation. Included are an assessment of the most suitable drugs for first-line treatment and guidelines for developing management plans for mild hypertension, moderate and severe hypertension, resistant hypertension, and hypertensive emergencies. In view of the need to assure that scarce resources are invested wisely, the report also discusses and compares the cost-effectiveness of different management strategies.
Prevention and Control of Cardiovascular Diseases
edited by A. Alwan
EMRO Technical Publications, Eastern Mediterranean Series, No. 22
1995, 65 pages [E]
ISBN 92 9021 205 5
Sw.fr. 5.-/US $4.50; in developing countries: Sw.fr. 3.50
Order no. 1450022
Describes the measures that can be taken to prevent or control cardiovascular diseases in Eastern Mediterranean countries. Addressed to policy-makers, the book responds to profound demographic, socioeconomic, and behavioural changes that have caused a sharp increase in cardiovascular diseases and made them a major cause of morbidity, disability, and death throughout the region.
The opening chapters provide basic information about risk factors for cardiovascular diseases, including the many linked to lifestyle, and describe different epidemiological patterns seen throughout the world. Chapter three summarizes the regional situation, providing data on risk factors and specific disease for each country in the region. Other chapters offer brief reviews of the impact of medical care and the global burden caused by these diseases. A chapter on prevention outlines opportunities for primary and secondary prevention for coronary heart disease, stroke, hypertension, and rheumatic fever and rheumatic heart disease. These opportunities are then assessed in terms of their appropriateness for inclusion in community-based intervention programmes. The concluding chapters establish priorities for prevention appropriate to the region, give guidelines for the development of national programmes, and map out a region-wide plan of action.
Prevention in Childhood and Youth of Adult Cardiovascular Diseases: Time for Action
Report of a WHO Expert Committee
Technical Report Series, No. 792
1990, 105 pages [C, E, F, R, S]
ISBN 92 4 120792 2
Sw.fr. 12.-/US $10.80; in developing countries: Sw.fr. 8.40
Order no. 1100792
Sets out the scientific rationale for an approach to the prevention of coronary heart disease that starts in childhood. Throughout the report, an effort is made to translate scientific knowledge about the causes of cardiovascular diseases into clear lines of preventive action, applicable in early life, that can be followed by parents, schools, physicians, and public authorities.
The book has two main parts. The first identifies risk factors for each of the main groups of cardiovascular diseases. Drawing upon decades of experimental, clinical, and epidemiological research, the report presents convincing evidence that the processes leading to cardiovascular disease start in childhood, that causative factors are directly linked to culturally-determined risks, and that prevention of these risks needs to be an integral component of childhood preventive care. The most extensive section concentrates on the potential of childhood interventions to protect populations from the current epidemic of atherosclerotic disease. The second half of the book offers guidelines for the immediate introduction of vigorous preventive measures.
"... contains information and guidelines
especially useful for community paediatricians ... For school doctors, the report is an
important reminder of their personal as well as professional role in health
Developmental Medicine and Child Neurology
"... packs in a remarkable amount of scientific
and practical information..."
Journal of the American Dietetic
Rehabilitation after Cardiovascular Diseases, with Special Emphasis on Developing Countries
Report of a WHO Expert Committee
Technical Report Series, No. 831
1993, viii + 122 pages [C, E, F, R, S]
ISBN 92 4 120831 7
Sw.fr. 17.-/US $15.30; in developing countries: Sw.fr. 11.90
Order no. 1100831
Sets out guidelines for the design and implementation of rehabilitation programmes aimed at improving the outcome of cardiovascular diseases and enhancing the patient's quality of life. Citing evidence from over 100 studies, the book underscores the many benefits that can be expected when all patients in all age groups are given appropriate care and counselling. Emphasis is placed on the importance of exercise as both a powerful non-invasive assessment tool and a key component of rehabilitative care.
In formulating guidelines and recommendations, the book gives particular attention to the needs of patients in developing countries, where rheumatic heart disease, hypertension, and cardiomyopathy are prevalent, and coronary heart disease is assuming growing significance. With these needs in mind, the book concentrates on the design of state-of-the-art rehabilitation programmes, tailored to diagnostic categories, that can be implemented even when resources are scarce and trained staff limited. Throughout the book, recommendations concerning methods of functional assessment, schedules of exercise, and staff and equipment requirements are given for three different levels of care, moving from a basic facility within the community, through hospital facilities, to an advanced cardiovascular rehabilitation centre linked to a major medical centre.
Information is presented in five sections. The first reviews recent developments in rehabilitative care, concentrating on advances that have made virtually all cardiovascular patients candidates for rehabilitation. The second section provides highly detailed advice on the design and implementation of cardiac rehabilitation in developing countries. Citing non-equipment-based rehabilitation as the most practicable option for developing countries, the book explains the components of rehabilitative care and exercise training according to diagnostic group, level of risk, and type of facility available. Readers are also given extensive advice on the assessment of patients for return to work, concentrating on the physical demands of activities commonly performed in developing countries.
The third section considers the special needs of children and young adults with cardiovascular disease, giving particular attention to the use of dynamic exercise testing to identify children or young adults who will benefit from exercise training. Readers are given advice on the clinical evaluation, recommended levels of physical activity, exercise testing, and exercise training for fourteen conditions. The remaining sections provide guidelines for the rehabilitation of the severely disabled, medically complex cardiac patient, and discuss current and future approaches to education as a vital part of rehabilitative care.