Introduction: Pandemic of obesity is strongly related to increase of chronic kidney disease (CKD) prevalence. Currently recommended CKD EPI equation has several serious limitations particularly in obese subjects who have high body surface area (BSA). The aim of our study was to analyze differences in the prevalence of CKD between CKD EPI and de-indexed equations where individual BSA was used. Methods: In total of 2058 subjects (random sample from general rural population, 29.65% obese) BSA was estimated using Dubois&Dubois and Moesteller equations and included into the de-indexed equations (CKD Di, CKD Mi). CKD was classified according to the KDIGO guidelines and glomerular hyperfiltration (GHF) was defined as 95th percentile according the gender and age decade. Results: In obese subjects, prevalence of CKD was significantly higher with CKD EPI than with CKD Di and CKD Mi equations (9.5%, 6.1%, 5.3%, respectively; p<0.001), while prevalence of GHF was significantly lower (3.8%, 12.3%, 12.8%, respectively; p<0.001). Opposite results were observed in subjects with BMI<25 kg/m2 for CKD (5%, 7.1%, 7.2%; p=0.07) and GHF prevalence (6.1%, 1%, 0.6%; p<0.001). Discussion/Conclusions: The prevalence of CKD is overestimated, and the prevalence of GHF is under-estimated in obese subjects using CKD EPI equation, i.e. CKD EPI equation is unreliable in one third of population. De-indexed equations should be recommended instead of CKD EPI equation in epidemiological studies until directly measurement of GFR become more available.

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.