Manual of Hypertension of The European Society of Hypertension
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These devices might be accessible to unskilled personnel for screening purposes. In , 9. Age-standardized and sex-specific stroke mortality rates in Great Britain for —, —, and — were higher for all migrant groups in each time period compared with men born in England and Wales, men born in West Africa or Bangladesh, and women from Jamaica having the highest rates. These findings bear similarities with the high stroke mortality of Surinamese and Antillean-born residents in the Netherlands .
There is consensus that among people of African origin, hypertension is three-fold to four-fold more prevalent than the native European population [75,—]. With few exceptions, incidence and prevalence of diabetes mellitus are also much higher among migrants than among locally born residents [11,,,]. In the UK, the incidence of end-stage renal failure among individuals from ethnic communities is three to five times greater than among the native population [,].
Should these data be confirmed in the different European countries, a future burden of cardiovascular myocardial infarction and stroke and renal disease dialysis can be expected in the next few decades with relevant implications in terms of costs for health systems of European Union member countries. However, many of the European Union programs have relied on the self-report of pathological conditions. This approach was useful to limit the costs of surveys, but sound data can only be obtained by directly assessing risk factors with the adoption of standardized forms to make results comparable between countries.
Migrants from LMICs usually develop cardiovascular complications in the medium-to-long term as a consequence of different environmental circumstances [77,—]. Cultural adaptations have great influence on the effectiveness of interventions among specific populations [—].
Therefore, intervention should not be focused only on the individual, but rather on the context and community; otherwise change may not be sustainable . Policy initiatives should, thus, improve data collection, to adapt organization of health systems to cultures, and to provide information to migrants on health problems and services. Europe as a whole is often perceived as a group of wealthy countries where inclusive social protection systems provide comprehensive protection for the most vulnerable [—].
However, in times of financial constraint, policy discussions often circle around cutting back social protection expenditures. Only four European Union member states Netherlands, France, Portugal, and Spain offered undocumented migrants access to primary care [,,] , but recent reductions in health expenditures pose severe threats and lead to decisions limiting healthcare to migrants without sufficiently investigating the impacts on those in need .
A reduction in access to primary and specialist care is indeed unlikely to be cost-effective, as use of emergency services will increase [,]. Current budget restrictions may also widen health inequalities, hurting other population groups in the dominant ethnic groups lower socioeconomic groups, the unemployed who comprise a very large group in Europe at present, those with limited education, and people with mental health issues .
The drive to cost-effectiveness should, thus, be coupled with seeing health as an investment, avoiding myopic short-term savings through arbitrary healthcare cuts.
Manual of Hypertension of the European Society of Hypertension, Third Edition
The establishment of culture of prevention in most LMICs requires the concerted action of television, radio, mass media-newspapers, and magazines, with the support of local health ministries and regulatory agencies, to limit salt intake and tobacco use. Cost-effectiveness of prevention treatments at the patient level requires a cardiovascular risk approach. Identification of patients with high-risk CVD may indeed restrict unnecessary drug treatment to low-risk patients. The adoption of a cardiovascular risk approach in population surveys has also relevant implications for healthcare resource allocation decision-making.
However, in low-resource settings, the screening or identification of those with very high risk from the population may be much more expensive than treating only hypertension. According to current evidence, some crucial points have to be considered both in surveys and patient care:. This is an interesting summary of a huge body of work and should be of interest to readers who missed the main issue of the Lancet dealing with the Global Burden of Disease early in The main limitation is that it is not novel, but it does provide an interesting European perspective.
Manual of Hypertension of the European Society of Hypertension, Second Edition | Semantic Scholar
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Your Email:. Colleague's Email:. Separate multiple e-mails with a ;. Thought you might appreciate this item s I saw at Journal of Hypertension. Send a copy to your email. Some error has occurred while processing your request. Please try after some time. Received September 21, Accepted January 9, Cardiovascular risk assessment in population surveys Implications for chronic kidney disease assessment in low-i Back to Top Article Outline. TABLE 1. TABLE 2. Global and regional mortality from causes of death for 20 age groups in and a systematic analysis for the Global Burden of Disease Study Lancet ; — Cited Here PubMed CrossRef.
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European Society of Hypertension position paper on ambulatory blood pressure monitoring.
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