site.btaOne in Two Bulgarians Lives with Untreated or Uncontrolled High Blood Pressure

One in two Bulgarians lives with untreated or uncontrolled high blood pressure, Prof. Kiril Karamfilov, head of the Cardiology Clinic at Alexandrovska Hospital and chairman of the Society of Cardiologists in Bulgaria, said here Thursday. He was speaking at a press conference at the National Press Club of BTA on the occasion of World Adherence Day, March 27.

Over 60% of deaths in Bulgaria are caused by cardiovascular diseases. This mortality has many causes, but the main ones are hypertension, stroke, and ischemic heart disease, with uncontrolled risk factors playing a leading role—prevention, not-so-easy access to diagnostics, late diagnosis, inadequate treatment, and not adhering to treatment. In Bulgaria, cardiovascular mortality is twice as high as cancer mortality, he added, and recalled that this indicator is six times higher compared to data from France, to take one example. The most serious risk factor is high blood pressure, which can be diagnosed early and controlled very effectively.

Nearly 2.4 million people in Bulgaria live with hypertension and many do not control it adequately.

Effective control means taking medications that have proven effective for the patient, Prof. Karamfilov added. According to him, adherence to the prescribed therapy is extremely important. The disability of patients is a serious problem in terms of the economic effects, he added.

Hypertension is a global problem, with 10.9 million deaths per year worldwide believed to be due to high blood pressure, said Prof. Arman Postadzhiyan, head of the cardiology department at Sofia's St. Anna Hospital and chairman of the Bulgarian Hypertension League. According to him, screening campaigns are extremely important because they enhance early detection and prescription of treatment. Many patients know they have high blood pressure, and 85% say they adhere to therapy, but in reality only half do, which is most unsatisfactory. Diagnosis and treatment are carried out well, but the problem lies in controlling the therapy. Without a clear focus on these problems, it is difficult to expect a change in the indicators. 

Diabetes, obesity, hypertension, and dyslipidemia are detected simultaneously in our patients mainly after the age of 50, and these conditions must be treated simultaneously, said Prof. Mihail Boyanov, endocrinologist at Alexandrovska Hospital and member of the Board of the Bulgarian Society of Endocrinology. If they are not treated simultaneously, heart attack or stroke incidence increases. The treatment of comorbid conditions requires taking multiple medications for life. There is no addiction to them, he noted, emphasizing that even when indicators normalize, therapy should not be stopped. According to him, reimbursement for combination medications should be increased, as this would reduce the number of tablets a patient has to take per day.

Data from an international study involving 3,200 Bulgarians show that the typical patient is 67 years old, 80% are obese, more than half have hypertension, and one-third have already experienced a cardiovascular event. According to Boyanov, diabetes has the best level of control among these diseases.

Dr. Stanimir Kachesmarov, a general practitioner said that of all doctors, patients most often visit their general practitioners, and therefore it is the general practitioner's responsibility to screen patients for the main risk factors and discuss how and whether they adhere to the prescribed therapy. It is important for patients to know their blood pressure values. If they are higher than 140/90, they should visit their general practitioner. According to him, a significant number of blood pressure measuring devices are not validated, and there is no guarantee they show correct values. Validated devices should be used, the doctor emphasized. According to him, one of the main reasons for non-adherence to therapy is that the patient feel well on some days.

According to the European Society of Cardiology, Europe is divided into four zones, and we are in the zone with the highest levels of cardiovascular disease, said Dr. Gencho Arabadzhiev, cardiologist. We must focus on combating high cardiovascular risk, as we cannot change patients’ sex and age, but we can change smoking, hypertension, dyslipidemia, and obesity, he added. There is evidence that the earlier hypertension therapy begins, the lower the risk of a cardiovascular event. 

"We have a comorbid nation, with a median age of just over 40 years, and Bulgarians often start therapy at a late stage, all of which leads to treatment with multiple medications," said Prof. Georgi Momekov, dean of the Faculty of Pharmacy at the Medical University of Sofia and chairman of the Bulgarian Scientific Society of Pharmacy. If the tablets are combined into one, this would improve adherence to therapy.

According to a study, 12% of patients do not follow their prescribed therapy at all, another 12% buy the medication, read the leaflet, and then refuse to take it, said Prof. Ivan Gruev, deputy director of the National Transport Hospital,  a specialist in preventive and sports cardiology, and chairman of the Society of Cardiologists in Bulgaria for the term 2026–2028. By the end of the first year, only half of patients adhere to the prescribed therapy, he added. According to him, risk factors are easy to avoid and are achievable goals, but the whole society must be engaged. We need a national awareness campaign, he added. We are developing a national cardiology plan, but it can only be implemented with the support of the authorities and society, the doctor also pointed out. According to him, the Bulgarian healthcare system is very accessible, but the reimbursement system is focused on treating diseases, not preventing them. Prof. Gruev urged people to take advantage of the preventive examinations and tests available to them annually.