Objective: Carotid-femoral pulse wave velocity (cfPWV) was recommended by guidelines as biomarker and independent predictor of cardiovascular (CV) events. Measurements of cfPWV is demanding and expensive method. It was suggested that an estimated PWV (ePWV) could be used. Our aim was to analyze the predictive role of ePWV for CV and all-cause mortality in general population. Design and method: In stratified random sample of 1087 subjects from the general Croatian adult population (EH-UH study) (men 42.4%, average age 53 +/-16) subjects were followed for 17 years. Mortality data were obtained from Croatian Institute of Public Health. In the follow-up period 1060 patients had all the data on death. ePWV was calculated using formula: ePWV = 9.587-0.402 × age + 4.560 × 10-3 × age2-2.621 × 10-5 × age2 × MBP + 3.176 × 10-3 × age × MBP-1.832 × 10-2 × MBP. MBP = (DBP) + 0.4(SBP-DBP). Results: At the end of follow up period 228 deaths (all-cause mortality 20.9%; CV, stroke, cancer, dementia and degenerative diseases, cold, others 43.4%, 10.5%, 28.5%, 5.2%, 3.1%, 9.3%, respectively). In the 2nd ePWV tertile there were more deaths due to cancer than from CV disease (46% vs. 30%), while in the 3rd tertile we observed opposite (20.5% vs. 51.04%). In the analysis of survival of subjects classified into the ePWV tertiles when all-cause and CV death and mortality were observed, the probability of survival of the 3rd tertile compared to the 2nd and 1st tertiles were significantly lower (p< 0.001 Log Rank test (Mantel-Cox)) (Figure 1). In unadjusted model, in Cox regression ePWV was significant predictor for CV death and for each increase of 1m/s there was 14% increase risk for CV death. In multivariate analyses ePWV was neither independent predictor for all-cause nor for CV mortality (p>0.05). However, in u subgroup of subjects with higher CV risk we found ePWV to be a significant predictor of CV deaths (ePWV (m/s) β 1.108; p<0.029; HR 3.03,95% CI 1.118-8.211). Conclusions: In general population ePWV is associated with higher all-cause and CV mortality, although not independently of other risk factors. However, in a subgroup of subjects with high CV risk, ePWV was significant and independent predictor of CV mortality. Further studies are needed before ePWV could be recommended in general clinic work.

Objective:Mediterranean lifestyle is slowly disappearing along the Croatian coast and Croatian islands were supposed to be the last part of healthy living. Unfortunately, healthcare system is poorer on islands than in other parts of Croatia. Our aim was to analyse lifestyle and hypertension (HT) treatment and control among inhabitants of the Croatian islands.Design and method:HSK was organised by the Croatian Society of Hypertension and conducted by the WG- medical students in hypertension. A screening site was set up at the boat by which students traveled from island to island. Adult volunteers were recruited through opportunistic screening on five Adriatic islands. Trained medical students collected information through an extended questionnaire. HT was defined as blood pressure (BP) > 140/90mmHg (single occasion; an average of 2nd–3rd measurement; Omron M3) and/or self-reported use of drugs for HT. Results were compared with results from the general Croatian population (EHUH 2 cohort).Results:A total of 424 participants were included (196 men, average age 61 years). There were less obese and current smokers at islands than in the general Croatian population (26.5% vs. 33.1%; 21.5% vs. 25%, respectively, p < 0.05). Islanders were more physically active (> 1 time/week), eat more frequently fish (> 1 time/week), and use more frequently olive oil (daily basis) (44.1% vs. 26%, 79.9% vs. 32.5%, 72.6% vs. 14.9 %, respectively; p < 0.01). However, there were no differences in consumption of red meat, processed meat, cookies and cakes (p > 0.05). Less hypertensive patients were treated and control was achieved in less subjects on islands than in the general population (60.7% vs. 72.9%; 27.2% vs. 39.3%, respectively; p < 0.01).Conclusions:Some elements of Mediterranean life are still present on Croatian islands. However, several poor lifestyle habits are equally present on islands and in other Croatian regions. Treatment and control of HT are poorer on islands reflecting inadequate healthcare and lack of physicians. Public health authorities should reorganize health care on islands. In the meantime, such public health actions are warranted and must continue.

Objective:Hyperuricemia is acknowledged cardiovascular risk factor and determination of uric acid is a routine laboratory test in arterial hypertension. Debate is going on whether asymptomatic hyperuricemia should be treated or not, and what should be the targets. Our aim was to analyze prevalence of asymptomatic hyperuricemia, treatment and control in general Croatian population.Design and method:EHUH -2 study is nation-wide survey (Croatian Science Foundation) on hypertension and numerous cardiovascular risk factors in Croatia. In 2018–2021 a random sample of 1321 subjects were enrolled. Extended questionnaire was applied and subjects were clinically examined. Office blood pressure (BP) and heart rate were measured in sitting position using Omron 3 device three times and average BP values were calculated. Fasting blood sample was drawn after measurements and all lab data including uric acid were determined in a central laboratory. Hyperuricemia was defined as uric acid > 428 umol/l for men and > 357 umol/l for womenResults:Prevalence of asymptomatic hyperuricemia was 12.6% without difference between men and women. Only 14.2 % of patients with asymptomatic hyperuricemia was treated with xanthine oxidase inhibitors. Normal values of uric acid were achieved in 71.5%. However, it means that in the entire group of patients with asymptomatic hyperuricemia only 10.1 % were under control.Conclusions:Prevalence of asymptomatic hyperuricemia is in line with reports from some countries (Italy 9–12%, Spain 5.11% and Sweden 10.16%), but lower than in North America, Russia, Japan and China. Small number of patients is treated and majority were not controlled. This therapeutic inertia should be improved by increasing awareness among physicians.

Objective:There are many reports on the seasonality of cardiovascular risk factors particularly of blood pressure (BP). Our aim was to analyze association of BP with various meteorological parameters in random sample of general Croatian adult population.Design and method:EHUH -2 study is nation-wide survey (Croatian Science Foundation) on prevalence, treatment and control of hypertension in Croatia. In 2018–2021 a random sample of 1321 subjects were enrolled. Office blood pressure (BP) and heart rate were measured in sitting position using Omron 3 device three times and average BP values were calculated. Estimated pulse wave velocity (ePWV) was calculated using validated equation. Meteorological data (mean daily 2 m air temperature – T2m, atmosphere pressure, air humidity measured at meteorological stations according to WMO standards) were collected in Croatian Meteorological and Hydrological Service.Results:We found significant difference in systolic and diastolic BP, heart rate and ePWV accorss nalys (Figure 1a and Figure 2), as well significant correlation between all parameters and T2m. (Figure 3 for systolic BP). There is nonsignificant trend in association between systolic BP and air humidity. We failed to find association of diastolic BP, heart rate and ePWV with any of nalysed meteorological parameters. Furthermore, we found inverse association between systolic BP, diastolic BP and heart rate with T2m i.e. we confirmed seasonal fluctuations (Figure 1b).Conclusions:Our data confirmed findings of seasonal (inverse) variation between BP and T2m. Interestingly, we found association of seasonal variation and ePWV. T2m has impact on long-term BP variability but also on ePWV and should be taken into account in clinical research as well as in regular clinical work.

Objective:Poor adherence is the main reason for inadequate blood pressure control. Pharmacists are highly accessible healthcare professionals, and it has been reported that community pharmacist-led interventions improved patients’ BP control and outcomes. Some authors reported on the beneficial effects of mobile applications on better drug adherence. The aim of this study was to identify subjects in the general population who may benefit from such interventions.Design and method:A total of 1228 subjects enrolled in the EHUH 2 study (a random sample, nationwide survey) and 424 participants of the Hunt on the Silent Killer (HSK) (opportunistic screening on islands) were included in this analyses. The same questionnaire was applied containing questions about health issues, therapy, habits, and opinion on pharmacists’ and mobile applications’ (MA) role in hypertension treatment.Results:The binomial logistic regression analysis showed a significant model when comparing positive and negative answers for the following: the participants were more likely to be in favour of pharmacists’ role if they had a positive history of angina pectoris ( = 1.333, p = 0.016), diabetes mellitus ( = 1.125, p < 0.001), dyslipidemia ( = 1.326, p < 0.001), or being treated for hypertension ( = 1.326, p < 0.001) in the HSK, and in the EHUH 2 study if they suffered a stroke (100%). Socio-demographic factors had no impact on the pharmacists’ role in the general population. However, at islands significantly enhanced negative responses in case of lower household income (35%), married state (29%) and employed subjects (17%) were observed. The participants were more likely to be in favour of MA if they had a positive history of hypertension, have higher income and were married. Interestingly, the history of cardiovascular diseases indicated more negative responses.Conclusions:The participants were generally in favour of MA, which may confirm the need to digitalise the healthcare system, but it was more enhanced in participants with a higher socio-demographic status. Pharmacists-led interventions (lifestyle support and adherence increasing programs) have to be individualized.