title: Hypertension prevalence, awareness, control and association with metabolic abnormalities in the San Marino population: the SMOOTH study.
abstract: BACKGROUND
  The aim of the SMOOTH (San Marino Observational Outlooking Trial on Hypertension) study was to explore hypertension awareness, treatment and control and the associated metabolic abnormalities and risk factors in the population of San Marino, a small state in the Mediterranean area, for which limited evidence is available.
  
  
  METHODS
  Nine general practitioners enrolled 4590 consecutive subjects (44% of the San Marino population age 40-75 years), seen in their office by collecting history, physical and laboratory data and office blood pressure (BP) measurements.
  
  
  RESULTS
  Of these subjects, 2446 were normotensive and 2144 hypertensive; 62.3% of hypertensive patients were aware of their condition, 58.6% were treated (monotherapy 31.5%, combination therapy 27.1%), and 21.7% were controlled. Hypertension awareness and treatment were more frequent above age 50 and in females; BP control was similarly low in both genders. As compared to normotensives, hypertensive subjects were less frequently smokers (20.1 versus 27.8%), had greater body mass index (28.1 +/- 4.5 versus 25.8 +/- 3.7 g/m), and a higher prevalence of diabetes mellitus (15.8 versus 6.3%), lower high-density lipoprotein (HDL) cholesterol and higher prevalence of increased blood total cholesterol (66.1 versus 51.3%), triglycerides and serum uric acid. Values of subjects with 'high-normal' blood pressure were closer to those of hypertensive subjects. The prevalence of metabolic syndrome was higher in hypertensive than in normotensive subjects, and in treated than in untreated hypertensives.
  
  
  CONCLUSIONS
  Even in a small Mediterranean country with high health-care standards, hypertension awareness, treatment and control are inadequate and hypertension clusters with metabolic abnormalities and risk factors as in non-Mediterranean areas.
authors.affiliation: Clinica Medica and Department Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università di Milano-Bicocca, Italy. giuseppe.mancia@unimib.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
authors.forename: Claudio
authors.initials: C
authors.lastname: Borghi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ghironzi
authors.forename: Egidio
authors.initials: E
authors.lastname: Andriani
authors.forename: Liano
authors.initials: L
authors.lastname: Marinelli
authors.forename: Mariaconsuelo
authors.initials: M
authors.lastname: Valentini
authors.forename: Francesco
authors.initials: F
authors.lastname: Tessari
authors.forename: Ettore
authors.initials: E
authors.lastname: Ambrosioni
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000886:Anthropometry; D001364:Awareness; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology*; D008075:Lipoproteins, HDL / Q000097:blood; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008403:Mass Screening; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D009819:Office Visits; D015995:Prevalence; D012307:Risk Factors; D012496:San Marino / Q000453:epidemiology; D017678:Sex Distribution; D014280:Triglycerides / Q000097:blood; D014527:Uric Acid / Q000097:blood
chemical_list: D001786:Blood Glucose; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL; D014280:Triglycerides; D014527:Uric Acid; D002784:Cholesterol