Turkey

Salt Action Summary

Turkish Society of Hypertension and Renal Diseases
World Hypertension Day 2008 and other activities

Introduction:

Turkish Society of Hypertension and Renal Diseases (TSHRD) is a member of World Hypertension League (WHL) and International Society of Hypertension (ISH). As a part of its mission and its loyalty to both WHL and ISH, TSHRD is celebrating the World Hypertension Day (WHD) with several activities since 2006. Starting from 2008, TSHRD has decided to start a nationwide blood pressure (BP) measurement campaign. The Society has also completed 2 important epidemiological field studies during 2008. One of the studies has investigated the incidence data of hypertension in Turkey. The other one looked for salt consumption and its relationship with blood pressure in Turkey. This brief report summarizes the WHD activities and major highlights of these studies.

1) WHD 2008: “Measuring blood pressure…of Turkey”

Turkey is a rapidly developing Mediterranean country with a population of 70 million. Turkey has a very young population; approximately 60 % of the population is under 35-years of age. Nevertheless, Turkey has a high prevalence figure of hypertension: age- and sex- adjusted prevalence was 31.8 % (27.5 % for men and 36.1 % for women) (Altun B, Arici M, Nergizoglu G, et al Journal of Hypertension, 2005; 23:1817-1823). This study which was carried out by TSHRD has also highlighted some more alarming figures about hypertension in Turkey (Figure 1). All these figures highlight an urgent need for developing an “action plan against hypertension” in Turkey.

As the theme for World Hypertension Day 2008 is "Measure your blood pressure... at Home!" TSHRD has started a nationwide blood pressure measurement campaign. The aim of the campaign is to increase the awareness of the public about high blood pressure and related disorders. The campaign was approved and supported by the Ministry of Health. The campaign has received unconditional support from several pharmaceutical companies (Abbott, Boehringer Ingelheim, Novartis, Omron, and Pfizer) and from a truck company (Scania). The campaign was planned as a road show and a “hypertension truck” (Figure 2) has travelled a 4000 km route visiting 9 major cities of Turkey (Figure 3). These cities have approximately 20 million inhabitants so that comprising one third of Turkey’s population. "Measuring blood pressure…of Turkey" is the name of the campaign. A dedicated website (www.turkiyenintansiyonu.org) was prepared for the campaign and both national and local media and public were continuously informed through the website, press releases and television and radio broadcasts. A special campaign song was composed and broadcasted through the campaign truck.

The campaign has started in Istanbul on 2nd May with a press conference in a major plaza (Eminonu Plaza) (Figure 4). The campaign finished on 16th May in Ankara, which is the capital of Turkey. In each city, the truck has stayed one or two days in the major plazas of the city. In the truck there were 4 nurses and 2 doctors who have measured people’s blood pressure. A questionnaire was filled before each blood pressure measurement. After each measurement, Turkish version of WHD 2008 leaflet (Figure 5) and several educational leaflets of TSHRD (Figure 6) were given to the participants. More than 60.000 leaflets were distributed. The leaflets were also present in campaign’s website for free download. An educational film was broadcasted in the truck from the monitors and doctors have answered any queries that people asked about hypertension. In each city, there were various other blood pressure stations in several areas such as shopping arcades, pedestrian shopping areas, and hospital entrances. In these stations, blood pressures were measured and information leaflets were distributed.

The major results of the campaign were as follows:

  • In 9 cities during 11 days, blood pressure was measured in 31,837 people. In the whole group 3,531 people (11.1 % of total) has never had their blood pressure measured before.
  • Among those people who had their first BP measurement during the campaign, 28.1% (30.4% in men and 25% in women) had BP readings above 140/90 mmHg (Figure 7).
  • During the campaign, blood pressure was measured in 11,685 people who were using antihypertensive drug(s). Only 34.6% of them had BP readings under control (< 140/90 mmHg).
  • In the whole group, there were 8,148 people who had hypertension and at least one of the following associated conditions: diabetes, heart disease or renal disease. The BP readings of these patients showed that 70.2% of them were higher than 130/80 mmHg.
  • All the people in the campaign were asked to list the most important causes for elevated blood pressure. The number 1 in the list is “stress”. It was followed by “unhealthy diet”, “salt consumption”, “genes”, “obesity”, “smoking” and “physical inactivity”.

All the other results is still being analyzed and planned to be published as an original article in either an international or national journal. A full report in Turkish may be reached through www.turkhipertansiyon.org (Society's website) or www.turkiyenintansiyonu.org (Campaign's website).

The Society has decided to continue this activity next year. The truck will visit 9 other cities of Turkey. It is planned to start on 15 May and end on 29 May, 2009.

2) Hypertension Incidence in Turkey (HinT) Study

TSHRD has carried out a nationwide hypertension prevalence (Prevalence, awareness, treatment and control of hypertension in Turkey-PatenT) study in 2003 and the findings were published in Journal of Hypertension (Altun B, Arici M, Nergizoglu G, et al. Journal of Hypertension, 2005; 23:1817-1823). Four years after the prevalence study, out of 4910 PatenT Study participants 4008 were reached (attainment rate was 81.6%) for hypertension incidence in Turkey (HinT) study. BP measurements were performed by specially trained and experienced health care workers in the households of the participants. A specific questionnaire was filled for each participant. 4-year adjusted incidence rate was found to be 21.3%. As expected the highest incidence rate was found to be in older (>65 years) individuals (4-year incidence rate: 43.3 %) (Figure 8) and in people with high-normal (>130/85 mmHg) blood pressure (4-year incidence rate: 50.7 %) (Figure 9). An improvement was observed in blood pressure control rates in this cohort. In 2003, overall control rate was only 8.1% in the whole hypertensive population and it was 20.7 % for the ones who were on antihypertensive treatment.  In 2007, these figures were 13.6% and 27.3%, respectively. During 4 year follow-up 173 people were died from the original cohort (4-year mortality rate was 4.3 %). The mortality rate was 4.5 times higher among hypertensives (4-year mortality rate was 9.0 %) compared to normotensives (4-year mortality rate was 2.0 %).

The major results are being prepared for submission as an original article and further analysis of the data is still ongoing. Major results in Turkish may be reached through the Society’s website.

3) Salt Intake and Blood Pressure in Turkey (SalTURK) Study

There is much evidence about linking salt intake and high blood pressure. Prevalence and incidence studies showed that hypertension is an important public health threat in Turkey. In order to better decipher the underlying causes, this epidemiological field study was first to investigate daily salt intake of Turkish population. A nationally representative sample of the adult (≥18 years old) population was selected from rural and urban areas of 14 cities. A total of 1970 normotensive and hypertensive people were included to the study. All participants were visited at their household by the trained health care workers (general practitioners and nurses) between January-April, 2008. A specific questionnaire was applied, blood pressure values were measured and 24-hour urine was collected for estimating salt intake in all participants.

Mean salt consumption was found to be 18.04 gr/day in the whole group. Women were consuming less (16.83 gr/day) compared to men (19.31 gr/day). There was statistical significance between educational degree and salt consumption. High school and university graduates were consuming more compared to ones with lower educational degrees. Hypertensive patients who were aware of their hypertension were consuming approximately 1.5 grams less than the general mean and 2.5 grams less than the unaware hypertensives. Obese people (Body mass index > 30 kg2/m2) were consuming more salt compared to less obese (18.91 gr/day vs 17,69 gr/day). When compared with INTERMAP data, Turkey has the highest daily salt intake compared to US, UK, Japan and China (Figure 9).

The major results are again being prepared for submission as an original article and further analysis of the data is still ongoing. Major results in Turkish may be reached through the Society’s website.

Conclusion:

In conclusion, Turkish Society of Hypertension and Renal Diseases continues its fight against hypertension and related disease. The Society believes that the information gathered from these studies does not only represent a country’s perspective in hypertension but also have global implications for preventive and therapeutic efforts.

Professor Mustafa ARICI, MD
General Secretary
Turkish Society of Hypertension and Renal Diseases

February 2008

World Salt Awareness Week

The Turkish Society of Hypertension and Renal Diseases made a valuable contribution to World Salt Awareness Week through the hard work of Professor Mustafa Arici and the Society’s executive board. A press release was adapted with locally relevant information from the WASH template and WASH resources. This was issued to the press, achieving a great response and high awareness across various media including the internet and national newspapers. The Week was also promoted through the Society’s website to its members, including the Ministry of Health of Turkey (www.turkhipertansiyon.org).

Current studies in Turkey include “Hypertension incidence in Turkey” and “SALTurkey: Salt consumption and hypertension in Turkey, which will be announced in the 10th Annual Congress of Hypertension and Renal Diseases (22–25 May 2008). The Society has great plans for future activity, incorporating World Salt Awareness Week with the results of SALTurkey and potentially promoting the Week with leaflets, posters, educational programs, radio and television spots.