title: Influence of dyslipidemia in control of arterial hypertension among type-2 diabetics in the western region of the Republic of Macedonia.
abstract: OBJECTIVE
  To determine the influence of dyslipidemia in control of blood pressure in patients with type 2 Diabetes. To test the hypothesis that, blood pressure and lipid levels are not sufficiently controlled in patients with type 2 Diabetes, in the western region of the Republic of Macedonia.
  
  
  BACKGROUND
  Abnormalities of lipid and lipoprotein levels in the serum (dyslipidemia) are recognized as major modifiable cardiovascular disease risk factors and have been identified as independent risk factors for essential hypertension, giving rise to the term dyslipidemic hypertension. While patient-related data from primary care that demonstrate an under-treatment of blood pressure and dyslipidemia in type 2 Diabetics are vastly available in clinical practice, results from population-based studies are scarce.
  
  
  METHODS
  The study was conducted on outpatients in Primary Health Care Clinics in 8 cities on the western region of the Republic of Macedonia. Prospectively the tests were performed on 600 (45.6% women and 54.4% men) participants with a mean age of 62 ± 5.8. Study participants were selected among primary care patients, who were actively on therapy for diabetes mellitus and hypertension during the period of March 2013 - March 2014. Patients' demographic characteristics, clinical laboratory and drug usage data were obtained. The patients were classified according to the BP control, into 2 groups.
  
  
  RESULTS
  A total of 600 patients, of which 45.6% female and 54.3% male, completed the survey and had data for a 1-year medical record review. It was observed that a high percentage, 65.3% of patients, did not have controlled blood pressure despite the ongoing medical treatment, according to evidence and current guidelines in a cohort of hypertensive diabetics. (Chi-square: 19.85, p<0.001). Among participants with controled BP, untreated or insufficiently treated dyslipidemia was recorded in 23% of them, whereas among participants with uncontrolled BP, untreated or insufficiently treated dyslipidemia was recorded in 67% of the participants. (Chi-square: 15.01, p=0.0001).
  
  
  CONCLUSIONS
  A significant influence of dyslipidemia on the control of blood pressure in patients with type 2 Diabetes, was observed in our study. In a small country as Republic of Macedonia (with a population of around 2.000.000, especially the western region with approximately 1/2 of the overall population), this study highlights the considerable lack of awareness and insufficient management of the most important preventable and treatable cardiovascular risk factors (hypertension and dyslipidemia). These findings provide a possible explanation of the steadily high cardiovascular mortality rate despite the clinical and therapeutic progress and accessibility. Besides current hospital-based prevention and pharmaceutical control measures, mass education campaigns, lifestyle interventions etc., emphasis should be given to the role of family doctor as a primary-care health provider.
authors.affiliation: Department of Cardiology, Faculty of Medicine, "Mother Teresa" University Tirana, Republic of Albania.
authors.forename: Ylber
authors.initials: Y
authors.lastname: Jani
authors.affiliation: Department of Cardiology, Faculty of Medicine, "Mother Teresa" University Tirana, Republic of Albania.
authors.forename: Amet
authors.initials: A
authors.lastname: Kamberi
authors.affiliation: Department of Internal Medicine, Faculty of Medicine Tetov.
authors.forename: Fatmir
authors.initials: F
authors.lastname: Ferati
authors.affiliation: Department of Internal Medicine, Faculty of Medicine Tetov.
authors.forename: Atila
authors.initials: A
authors.lastname: Rexhepi
authors.affiliation: Department of Cardiology, Faculty of Medicine, "Ss Kiril and Metodij" University Skopje, Republic of Macedonia.
authors.forename: Bekim
authors.initials: B
authors.lastname: Pocesta
authors.affiliation: Institute of Biostatistics, Faculty of Medicine, "Ss Kiril and Metodij" University Skopje, Republic of Macedonia.
authors.forename: Nikola
authors.initials: N
authors.lastname: Orovcanec
authors.affiliation: Private Health Institute of Family Medicine "Florenc" Tetovo.
authors.forename: Dali
authors.initials: D
authors.lastname: Lala
authors.affiliation: Private Health Institute of Family Medicine "Polisi" Struga.
authors.forename: Gafur
authors.initials: G
authors.lastname: Polisi
authors.affiliation: Private Health Institute of Family Medicine "Poli-Medika" Gostivar.
authors.forename: Mair
authors.initials: M
authors.lastname: Iseni
authors.affiliation: Private Health Institute of Family Medicine "DR Mirto" Gostivar.
authors.forename: Arben
authors.initials: A
authors.lastname: Mirto
authors.affiliation: Department of Internal Medicine, General Hospital "DR Ferit Murat" Gostivar.
authors.forename: Agim
authors.initials: A
authors.lastname: Zeqiri
keywords: Control; Type-II diabetics; arterial hypertension; dyslipidemia