According to the Organisation for Economic Co-operation and Development (OECD) cardiovascular diseases remain the leading cause of death in most OECD countries.
In 2016, circulatory system diseases were responsible for 32,805 deaths in Portugal (about 30% of mortality). Risk factors associated with CVDs include age, gender, ethnicity, family history, tobacco use, hypertension, diabetes mellitus, obesity and a sedentary lifestyle, and dyslipidemia.
Blood pressure (BP) is the force with which blood circulates through the blood vessels in the body. However, there are a number of factors — genetic and environmental — that can cause this pressure on the artery walls to excessively increase. This scenario corresponds to arterial hypertension (HTN).
According to several studies, it is estimated that 30-45% of the population of Europe suffers from hypertension and Portugal is no exception to these figures. Currently, 42.2% of the adult population in Portugal has high blood pressure. However, it is estimated that only 75% of these people are on medication and only 42% have effectively controlled their hypertension*.
It is precisely because of the fact that there is such a high percentage of patients whose hypertension is not controlled or corrected that hypertension is one of the main risk factors for the onset of cardiovascular disease.
Sources:
*Polonia J, Martins L, Pinto F, Nazare J. Prevalence, awareness, treatment and control of hypertension and salt intake in Portugal: changes over a decade. The PHYSA study. J Hypertens 2014;32:1211-21.
Age, obesity, excessive alcohol consumption, smoking, poor diet, excessive salt intake, sedentary lifestyles, and stress are some of the risk factors for the development of hypertension.
Blood pressure is measured in two ways: the systolic or “maximum” blood pressure and the diastolic or “minimum” blood pressure. The first corresponds to the moment when the heart contracts and pumps blood throughout the body. The second occurs when the heart relaxes to fill itself with blood again.
Blood pressure should ideally be less than 120/80. Above these values, there is an increased risk of coronary heart disease or stroke.
Definitions and classifications of blood pressure levels (mmHg)
|
CATEGORY |
SYSTOLIC |
DIASTOLIC |
|
Excellent |
<120 |
<80 |
|
Normal |
120-129 |
80-84 |
|
Elevated |
130-139 |
85-89 |
|
Hypertension stage 1 |
140-159 |
90-99 |
|
Hypertension stage 2 |
160-179 |
100-109 |
|
Hypertension stage 3 |
≥180 |
≥110 |
- Your blood pressure should be checked in a calm environment after 5 minutes rest. You should not have smoked, taken any stimulants, or done any exercise in the 30 minutes prior to measuring your blood pressure;
- You should be in a sitting position with your back and arms supported;
- Blood pressure should be measured in the arm that consistently shows higher blood pressure values;
- Blood pressure testing should be done for at least 3-4 days, preferably for 7 consecutive days, twice a day: in the morning and in the afternoon;
- Each time blood pressure is taken, two separate measurements should be taken, 1-2 minutes apart;
- Record the measurements taken, as well as the date and time. Share this record with your healthcare provider.
It has been proven that changing a few lifestyle habits is often enough to lower blood pressure levels. This includes:
- Limiting the consumption of salt;
- Eating fruit, vegetables, and salads;
- Doing more exercise;
- Avoiding alcohol;
- Reducing stress;
- Losing weight (if overweight).
Patients with hypertension have a higher risk of death or of developing certain conditions, such as heart failure, strokes, myocardial infarction, kidney failure, gradual loss of vision, sclerosis of the arteries, among other things.
The adoption of a healthy lifestyle can prevent the onset of the disease and early detection and follow-up can reduce the risk of developing these conditions.
Dyslipidaemia is a term used for all quantitative or qualitative abnormalities in blood lipids (fats).
Dyslipidaemia can manifest itself in various ways:
- By an increase in triglycerides (TG);
- By an increase in cholesterol (Total Cholesterol and LDL-Low Density Lipoprotein – also known as “bad” cholesterol);
- By mixed dyslipidemia, which corresponds to moderately elevated LDL levels, elevated TG levels and HDL – High Density Lipoprotein levels;
- And also by a reduction in the levels of HDL – High Density Lipoprotein – also known as “good” cholesterol.
In Portugal, studies have shown that 39.2% of people had high TG levels (> 150 mg/dL) and 22.2% had low levels of “good cholesterol” HDL (< 40 mg/dL in men or 46 mg/dL in women). *
Any type of dyslipidemia poses a risk for cardiovascular disease (CVD), since it is associated with the development of atherosclerosis, which can lead to partial or total obstruction of blood flow in the arteries and result in a cardiovascular event, such as heart attack, stroke, or transient ischaemic attack (TIA).
Some of these risk factors can be alleviated and controlled through lifestyle changes.
Source:
*Mello e Silva A, Aguiar C, Duarte JS, Couto L, Veríssimo MT and Marques da Silva P. CODAP: A multidisciplinary consensus among Portuguese experts on the definition, detection and management of atherogenic dyslipidemia. Rev Port Cardiol; Available at: https://www.revportcardiol.org/pt-codap-um-consenso-multidisciplinar-sobre-articulo-S0870255118306358 DOI: 10.1016/j.repc.2019.03.005
In 2015, the estimated prevalence of diabetes among the Portuguese population aged between 20 and 79 years (7.7 million individuals) was 13.3% which means that more than one million Portuguese people in this age group have diabetes. *
Sources:
*Observatório da Diabetes. Annual Report of Observatório Nacional da Diabetes [National Diabetes Observatory] – published 2016. Sociedade Portuguesa de Diabetologia [Portuguese Diabetes Association] [Online]. 2016 [cited 14 Apr 2021]; Available at: https://apdp.pt/publicacoes/relatorio-anual-do-observatorio-nacional-da-diabetes-2016/
There are several types of diabetes:
- Type 1 Diabetes
- Type 2 Diabetes
- Gestational Diabetes
Apart from Type 1, Type 2, and Gestational Diabetes, there are other types of diabetes but they are much less frequent.
Type 1 Diabetes, also known as insulin-dependent diabetes, is rarer (its juvenile form does not represent even 10% of the total) and affects mostly children or young people, but may also appear in adults and even the elderly. In Type 1 Diabetes, the ß-cells of the pancreas stop producing insulin because there has been a massive destruction of these insulin-producing cells. The causes of Type 1 diabetes are still not fully understood.
However, it is understood that in people with diabetes it is the body's own defence system (immune system) that attacks and destroys their β-cells.
People with Type 1 Diabetes need lifelong insulin treatment because their pancreas can no longer produce it. This type of diabetes is not directly related to poor lifestyle or eating habits, unlike Type 2 diabetes.
The main risk factors for Type 2 Diabetes are obesity, a sedentary lifestyle, and genetic predisposition. It is undoubtedly the most common type of diabetes. It is caused by an imbalance in insulin metabolism.
With Type 2 Diabetes, there is an insulin deficit and insulin resistance. At an early stage, people with higher insulin resistance may have higher insulin values and normal glucose values in an attempt by the body to compensate for the resistance. As time passes, the body finds it more difficult to compensate for this imbalance and glucose levels rise.
Although it has a strong hereditary component, this type of diabetes can be prevented by managing the modifiable risk factors.
Gestational Diabetes is diabetes that occurs during pregnancy. This form of diabetes appears in pregnant women who did not have diabetes before pregnancy and usually disappears when their pregnancy is over.
However, almost half of these pregnant women with diabetes will later develop type 2 diabetes if preventive measures are not taken.
Gestational Diabetes occurs in about 1 in 20 pregnant women and if it remains undetected by tests and if the hyperglycaemia is not corrected through diet and sometimes insulin, this can cause pregnancy complications for both mother and child. It is common for this to cause babies to be born weighing more than 4 kg and for caesarean sections to be necessary at the time of delivery. Miscarriages can also occur, for instance.
A diabetes diagnosis is made by assessing symptoms and is confirmed by blood tests.
Symptoms related to excess blood sugar appear gradually and often slowly in type 2 diabetes. The most frequent symptoms are fatigue, polyuria (urinating a lot and more frequently), and excessive thirst.
Often the patient has no symptoms (or pays them no heed) and the diagnosis is made by routine tests.
In the tests, an increased amount of sugar is found in the patient's blood (hyperglycaemia) and sugar appears in their urine (glycosuria).
Someone may be suffering from diabetes if:
They have occasional blood glucose levels of 200 mg/dL or higher with symptoms
They have a fasting (after eight hours) blood glucose of 126 mg/dL or higher on two separate occasions within a short period of time
