Epidemiology of hypertension:: selective results of population-representative studies in Southern and Northern Germany

Background and objectives: The mortality rate from cardiovascular disease is higher in northern than southern Germany. To illuminate this further current epidemiological data on arterial hypertension were obtained and compared with previously collected data. Methods: The results were based on interview and measurement data of 25- to 64 year-old participants in the Study of Health in Pomerania (SHIP-0 1997-2001; n=3,042), and three population-representative surveys in the region of Augsburg, Southern Germany (MONICA S2 1989/90 n = 3,966; MONICA S3 1994/95 n=3,916; S4 1999-2001 [KORA-2000 n=3,464]). Hypertension was defined according to the WHO/ISH guidelines as blood pressure levels of >= 140/90 mmHg or antihypertensive medication given the subjects with known hypertension. Antihypertensive medication was classified as recommended by the German Hypertension Society. Results: Currently, 57% (95% confidence intervall [CI] 54-59%) of men and 32% (CI 30-35) of women in Pomerania had hypertension compared to 36% (CI 34-38%) and 23% (CI 21-25%) in KORA-2000 with some decreases since MONICA S2 und S3. Although a significantly higher prevalence was found in the north than in the south, the medical care was equally poor in both regions: 44-46% of men and 29-31% of women were not aware of their hypertension. Among the hypertensives, only 26-31% of males and 44-48% of females were being treated for hypertension, mostly with beta blockers, ACE-inhibitors, calcium antagonists, diuretics and AT(1)-antagonists, at least half being given just one of these drugs. Fewer than half of the treated hypertensives were normotensive, regardless of the anti hypertensive drug group that was given. Conclusion: As the overall situation regarding the treatment of hypertension remains inadequate, an aggressive approach to applying the evidence-based guidelines is essential. The underlying causes of this unacceptable degree of hypertension control requires further intensive investigation.