Objective: Bulgaria is one of the leading countries in terms of premature mortality due to stroke with 6406,4 years of life lost per 100000 (95% CI 5211,7 to 7763,4) according to the data from Global Burden of Disease for 2019. In the same year The May Measurement Month (MMM) initiative was implemented in the country aiming to raise hypertension awareness and control. The aim of the study was to identify whether national-level MMM hypertension parameters are associated with national stroke mortality statistics. Design and method: Three BP readings and self-reported demographic, lifestyle and cardiovascular risk factors were collected from 3678 participants during MMM2019 campaign. National stroke mortality statistics and Socio-Demographic Index (SDI) were extracted from the Global Burden of Disease (GBD) study 2019. Hypertension was defined as a raised BP (systolic BP > 140 mmHg or diastolic BP > 90 mmHg based on the mean of the second and third readings), or on antihypertensive medication. Logistic and linear regression were applied, respectively, to the association between hypertension and stroke and between national-level GBD stroke mortality with MMM proportions with raised, treated and uncontrolled BP. Results: Overall we notice a relatively high proportion of participants with a previous stroke 237 (6.4%). Stroke survivors were older (69 vs 58,1, p < 0.001), with higher levels of systolic BP (139,4 vs 134,9 mmHg), but lower diastolic BP (80,2 vs 82,5 mmHg) and significantly more frequent concomitant coronary and peripheral arterial diseases, diabetes or heart failure (p < 0.001 for all). The proportion with previous atrial fibrillation was also higher among previous stroke patients 13,9 vs 5,6%. Stroke mortality increased, on average, by 680 per 100,000 per 1% increase in the proportion of individuals with raised BP (p = 0.006) and by 909 per 100,000 per 1% increase in proportion with treated but uncontrolled BP (p = 0.012). The corresponding years of life lost due to ischemic stroke were 736 (p = 0.015) and 172 per 100000 (p = 0.0005) due to hemorrhagic stroke per 1% increase in proportion with suboptimally treated BP. Conclusions: There was a significant association between national stroke mortality from GBD and the proportions of participants with raised BP and of hypertensives treated but uncontrolled in MMM. This suggests that despite lacking a population-based design, estimates from MMM broadly reflect rates of downstream mortality and that opportunistic screening can be an effective means not only of screening for hypertension, but of improving control of the patients already treated. The data presented gives rational for using estimates to inform policy and to start national campaign in order to change the existing tendencies.

Objective: Hypertension remains a major public health issue with inadequate control worldwide. The May Measurement Month (MMM) initiative by the International Society of Hypertension was implemented in Bulgaria in 2019 aiming to raise hypertension awareness and control. Increased arterial stiffness may indicate high cardiovascular risk, but little is known about its prevalence at the population level. Design and method: Adult volunteers (>18 years) were recruited through opportunistic screening in 21 of 28 administrative areas in the country. Information on medical history and triplicate sitting blood pressure (BP) measurements were obtained using validated automated upperarm devices. Aortic pulse wave velocity (aoPWV) was estimated, using age, systolic BP, and waveform characteristics. Using age-specific percentiles from a nonhypertensive group, we defined healthy (HVA) and early (EVA) vascular aging. Results: A total of 3678 participants were analyzed [mean age 58.8±16.5 years, men 37.2%, 71.2% had BP measurement in the last 12 months]. Mean BP was 135/82 mm Hg. In all, 45.4% of participants had elevated BPs (>140/90 mm Hg), 58.3% out of 1910 participants with known hypertension, and 31.4% out of 1768 participants without known hypertension. In all, 4,67% of participants had aoPWV below 10th reference percentile (HVA), with a negligible proportion above 50 years. In total, 40.5% were above the 90th reference percentile (EVA), with proportions rising from one-quarter in youngest partcipants bellow 50 to one-half in oldest participants. In participants with EVA, BP was elevated during the measurement in 82.6%. Among participants without established HTN, according to European guidelines in 18.4 % BP was elevated, when measured during the campaign. The lowest proportion of newly diagnosed hypertension was found in HVA group – 4.8% and the highest 30% in EVA group. Figure 1 gives information for blood pressure measured according to quintiles of vascular aging groups. Conclusions: The prevalence of hypertension in Bulgaria is high, with considerable potential for improving awareness, treatment, and control. The high prevalence of early vascular aging and higher incidence of newly diagnosed hypertension in this group of patient at early age is alarming.

Objective: Despite the increased prevalence of atrial fibrillation (AF), data for the implementation of nationwide screening programmes are limited. The use of automatic devices for blood pressure measurement with AFIB technology during May Measurement Month (MMM) give a unique possibility to increase nationwide awareness about AF and stroke risk, to determine the prevalence of AF using a validated BP machine and its feasibility to identify new cases. Design and method: Three BP readings and self-reported demographic, lifestyle and cardiovascular risk factors were collected from participants during MMM2019 campaign in Bulgaria. BP was measured using a Microlife WatchBP Office BP monitor with patented AFIB algorithm in 2075 participants. A regression analysis was performed excluding all the subjects with previous AF to establish clinical factors significantly associated with incident AF. Results: The mean age of participants was 62.11 ± 14.9 years, 65% were female and 66% with known hypertension with a median duration of 11 years. Past history of AF was present in 223 (10,7%) and during the campaign additional 83 (4%) cases were identified. Among 306 subjects with AF, low-risk patients (i.e. CHA2DS2VASc score 0 in males or CHA2DS2VASc score 1 in females) was found in 5 (3.8%) males and in 13 (7.6%) females, respectively. We didn’t found any significant difference in classical risk factors or cardiovascular diseases between the groups of previous and incident AF and both groups had identical CHA2DS2VASc score 3.56 vs 3.62, p = 0.8. On multivariable logistic regression CHF (P = 0.011), age 65–74 (P < 0.001) and = >75 (P < 0.001), diabetes (P < 0.01), previous stroke (P < 0.01) or vascular disease (P < 0.01), and prolonged history of hypertension with uncontrolled systolic BP during the screening (P = 0.012) or home systolic BP (P = 0.05) were significantly associated with incident AF. Conclusions: The use of automatic devices for BP measurement with AFIB technology is feasible to identify a significant number of new AF cases, most with a high thrombo-embolic risk. Given the low OAC use recorded, greater efforts in AF detection and treatment are urgently needed to reduce the burden of stroke associated with this arrhythmia.

Background and Aims: The aim of our study was to analyze the presence of hypertension and dyslipidemia among young people in the Pleven.

Background and Aims: Our aim was to determine waist and waist/hip ratio in young people assessing for heterozygous familial hypercholesterolemia (HeFH).

Background and Aims: Describe Bulgarian patients prescribed evolocumab in clinical practice

Objective: Our aim was to analyse the presence of essential hypertention in group of patients, estimated to have familial hypercholesterolemia (FH) in population according to Dutch Lipid Network Criteria (DLNC). Design and method: A Querstionaire based cross sectional study among young patients aged 18–60 years, was carried out in 59 patients, who were hospitalized in Department of Cardiology in period January, 2015 to February, 2015. Blood was taken for laboratory tests. Results: We found that 3,39% (n = 2) of the patients estimated for FH according to DLNC had probable FH; 42,37%(n = 25)- had possible FH and 54,24% (n = 32) had unlikely FH. In group with probable FH 100% (n = 2) of the patients had hypertention; with possible FH-8,0% (n = 2) had no hypertention, 52,0% (n = 13) had hypertention under 5 years; 24,0% (n = 6) had it between 5–10 years and 16,0% (n = 4) had hypertention above 10 years. Patients in unlikely FH's group that had no hypertention were 2 (6,25%), with hypertention bellow 5 years- 12 (37,5%); 8 of them had hypertention between 5–10 years (25,0%) and 10 (31,25%)- hypertention above 10 years. Conclusions: Our results showed the prevalence of patients with essential hypertention in observed group estimated according to DLNC. This can help us to determine risk patients with these two important diseases- FH and hypertention, and to prevent early disorders of target organs.

Objective: The objective of this study is to find the relationship between polymorphisms rs699 in the promoter angiotensinogen encoding a functional change in the final product, and the early manifestation of hypertension and the existence of the earlier target cardiac damage in young hypertensive patients. Design and method: The prospective study design includes a selection of the target group - young hypertensive patients aged 18–50 years with high blood pressure, defined as cases, and the control group includingsame age patients without hypertension. A questionnaire containing demographic, anthropometric and clinical data on the examined groups was used. Blood for genetic analysis was taken, and echocardiography was performed for studying target organs damage. The methods used for DNA analysis were TaqMan- PCR and PCR-HRM. An appropriate statistical analysis were (Fisher exact test,chi-square test, central tendency and descriptive statistics) done to compare groups. Results: The study showed that in a total of 78 subjects (48 young hypertensives and 30 controls) the frequency of the tested polymorphism was 59.0%. As 70.8% (34 patients) of young hypertensive patients werecarriers of rs699 and only 40% (12 patients) in the control group hadthe same polymorphism. RR(risk ratio) for early hypertension in rs699 carriers is eRR = 1.69 (1.15–2.48), p = 0.01 (Fisher exact test). Analysis of data from surveys and echocardiography showed that 96% of young hypertensive carriers of this polymorphism had hypertension onset of about 30 years had expressed LVH and diastolic dysfunction. Conclusions: Our results showed that the frequency of rs699 polymorphism was significantly higher in young hypertensive patients with essential hypertension compared with none-hypertonic in the same age. Also, the presence of this SNA polymorphism in the genome was associated with an earlier manifestation of hypertension and earlier target heart damage.

Objective: To evaluate the predictive factors for occurrence of atrial fibrillation in hypertensive patients. Design and method: Overall, 3684 volunteers with AH from 11 cities of Bulgaria participated in a cross-sectional study on the World Hypertension Day in 2014 and 2015. Same structured questionnaire was applied in the two surveys with questions about the registered episodes of AF, symptoms, treatment, demographic characteristics, diabetes mellitus, and home blood pressure measurement (BP). The BP, heart rate, weight and waist circumference were measured, BMI was calculated. Results: The mean age of the participants was 59.81 ± 16.44 years, 55% were female. The median duration of AH was 9 years. AF was present in 386 (11%) of them and in 282 (73%) of those with the arrhythmia it was treated, with no difference by year of examination or gender. New AF was diagnosed in 4% in this hypertensive population. The mean blood pressure was 141.86 ± 22.14/85.46 ± 11.97 mmHg in males and 133.75 ± 20.27/79.67 ± 10.99 mmHg in females (p < 0.001). The prevalence of AF was not significantly correlated with the BP values or with the quartiles of the BP distribution. However, the mean duration of AH was significantly longer in the patients with the arrhythmia compared to those in sinus rhythm – 14.1 vs 10 years for the known AF (p < 0.0001) and 14.75 vs 10.65 years for new AF (p < 0.0001). The hypertensive patients with AF (new or known) had almost twice more frequently duration of AH longer than the median (>9 years) than those without the arrhythmia – 23.4% vs 12.2% (p < 0.0001). In multiple logistic regression analysis, the hypertensive patients with onset of their AH more than 9 years had twice higher risk of developing AF (RR = 2.03, 95%CI 1.52–2.69, p < 0.0001), after adjustment for age, sex, measures of obesity, presence of diabetes, and BP. Conclusions: The prevalence of AF in an urban hypertensive population was approximately 1 in 8. Neither the present values of BP nor the severity of AH at the moment had effect on the occurrence of AF. The most powerful predictor of AF was the duration of AH more than the median.

Objective : The objective of this study was to analyses the major risk factors for coronary artery disease (CAD) for patients with ischemic heart disease in Kerala. Design : A cross-sectional study among patients with established CAD admitted in the Department of Cardiology during the month of June-Dec 2012. Setting : Study was carried out in a tertiary cardiac center in Kerala. Participants: A total of 496 patients who were admitted in the Cardiology department between June 2012 and December 2012 with acute coronary syndrome or coronary angiographic or Electrocardiography evidence of ischemic heart disease. Risk factors studied were the conventional risk factors for coronary artery disease - hypertension, diabetes mellitus, dyslipidemia, body mass index (BMI), smoking, and family history of coronary artery disease. Data are collected from the patients, old medical records, Clinical Examination and Laboratory results of the patients were analyzed for the study. Results: From the study, it was seen that in Keralites-irrespective of gender, diabetes or impaired glucose tolerance (79%) and dyslipidemia (71%) are the major risk factor for Coronary artery disease. Hypertension (39%) and cigarette smoking (24%) were not seen to be a major risk factors for coronary artery disease as only a minority of the study population had hypertension or gives a history of cigarette smoking. 57% of the study population had a family history of coronary artery disease. Among the studied population, 55% of females are with increased BMI, whereas only 16% of males with CAD were with BMI above 30. Conclusion: Among South Indian population irrespective of gender, diabetes mellitus and dyslipidemia are the major Risk factor for Coronary artery disease. So early detection of diabetes mellitus and dyslipidemia and proper treatment of both, before developing the end organ damage, play a vital role for the prevention of coronary artery disease.

Objective: The objective of this study is to analyse the effect and side-effects of combination therapy of Olmesartan/Amlodipine in the treatment of Resistant Hypertension. Design and method: Querstionaire based cross sectional study among patients with Resistant Hypertension according to the 2013 ESC Guideline for management of Hypertension. Study was carried out in 64 patients admitted with history and holter blood pressure monitor evidence of Resistant Hypertension in the Cardiology Department between 1 st of July 2013 and 31 st of July 2014. Patients who fulfilled the inclusion criteria by the initial holter blood pressure moniter were started on combination therapy with Olmesartan/Amlodipine along with diuretic and Beta-blocker. Patients were analysed with control questionaire and holter blood pressure monitor after 3 months for the effect and side-effects and the circadian rythm of blood pressure control. Results: From the study it was seen that 45 (70.31%) of the patients included in the study had reached optimal control of blood pressure. 10 patients (15.64%) had non optimal control of blood pressure, 3 patients (4.68%) stopped the treatment due to pedal oedema. 6 patients (9.37%) patients continued to be with resistant hypertension inspite of our maximal therapy. From the initial holter blood pressure monitering it was observed that 19 patients (30%) included in the study were non- dippers and after the therapy with Olmesartan/Amlodipine combination it was found that only 7 patients (10.93%) were non- dippers. Conclusions: From our study we observed that the combination therapy with Olmesartan/Amlodipine in patients with Resistant Hypertension has high efficacy and minimal side-effects with good circadian control of Hypertension.

Objective: To assess the prevalence of arterial hypertension (AH) and asymptomatic atrial fibrillation (AF) in three age groups – Group 1 - Young (18÷44 yr.), Group 2 - Middle-aged (45÷64 yr.) and Group 3 - Elderly (>65 yr.) in Bulgarian urban population. Design and method: A cross-sectional pilot study was organized on World Hypertension Day (17 may) 2014 by Bulgarian Hypertension League, National Organization of Medical Students and Microlife - Bulgaria. Open – air stands were been organized in 11 Bulgarian cities. Structured questionnaires were filled, blood pressure (BP) was measured by automatic devices with AFIB technology of Microlife for diagnose of atrial fibrillation (AF) without ECG. Voluntary participated 1833 persons (18÷98 yr.), mean age - 59.83 yr. (SD - 16.41); 56% females (F) and 44% males (M). Results: The following prevalence of AH in different age groups was found: Group 1 (mean age - 32.07 yr.) - 18.75%; Group 2 (mean age - 55.82 yr.) - 47.8%; Group 3 (mean age - 73.51 yr.) - 58.9%. The prevalence of newly detected (asymptomatic) AF for all groups was 3.74%, F - 2.55% and M - 5.15 %. The following rates of awareness for AH in persons with newly detected AF within separate age groups were found: Group 1 – Yes- 20%, No - 60%, Don’t know - 20%; Group 2 - Yes- 63.64%, No -27.27%, Don’t know - 9.09%; Group 3 – Yes- 58.4%, No- 31.70%, Don’t know- 9.75%. Regular BP measurement at home was found in: Group 1 - 11.11%, Group 2 - 45.46%, Group 3 - 26.83%. The following incidences of regular antihypertensive treatment in persons with newly detected AF within three groups were found: Group 1 – Yes - 0%; Group 2 – Yes - 77.77%; Group 3 – Yes - 70%. In same persons Diabetes Mellitus was found – Group 1 - 0%, Group 2 - 9.09%, Group 3 - 19.51%. Conclusions: Prevalence of AH and Diabetes Mellitus increases with age, but the prevalence for persons with newly detected AF is higher in middle age group. This group needs more attention.