104 Chapter 5 Data collection and definitions Trained staff extracted information on demographic variables and cardiovascular risk factor information from medical records. During the interview, taking place 6 to 24 months after the index event, participants provided self-reported information on lifestyle, cardiovascular risk factors and medication use. Fasting venous blood samples were drawn to measure glucose and lipids. Educational level was defined as the highest level attained by the participants and classified as primary, (patients without formal schooling, or who completed primary education or lower levels), secondary (secondary or high school) or tertiary education (including technical training, college/university, or post-graduate education) (12). Current smoking was defined as self-reported smoking and/or a breath carbon monoxide >10 ppm (10). Physical activity was classified as exercising less than or at least an average of 5 times a week for a duration of 30 minutes. Height and weight measurements were conducted in light indoor clothes by use of SECA scales 701 and measuring stick model 220 (10). Patients were classified as overweight if their body mass index (BMI) was ≥25 and <30kg/m2 and obese if it was ≥30 kg/m2 respectively (10). Diabetes was defined as self-reported diabetes diagnosed by a physician or use of hypoglycemic medication (1). LDL cholesterol levels were calculated with Friedewald’s formula (13) and were considered elevated if they exceeded 1.8 mmol/L (14). Definition of hypertension, awareness, treatment and control Patients were considered hypertensive if their blood pressure measurement during the interview was ≥140/90mmHg (≥140/85mmHg in diabetic patients); or if they both reported to use antihypertensive medication prescribed to reduce blood pressure and had a history of hypertension (communication by a health professional that they had raised blood pressure or hypertension in the medical records) (Table 1) (5). Blood pressure was measured twice with automatic digital sphygmomanometer (Omron M6) and the mean of the measurements was used for analysis. Hypertension awareness was assessed based on three questions during the interview. Patients were considered aware if they reported all three of the following: a) being told by a health professional they had raised blood pressure, b) being aware of their BP target, and c) being aware of their latest BP measurement (Table 1). Anti-hypertensive treatment was defined dichotomously as use of any antihypertensive medications (including beta-blockers, ACE inhibitors, angiotensin II receptor antagonists, renin inhibitors, calcium channel blockers, diuretics, or other anti-hypertensive drugs) specifically to lower blood pressure (Table 1). Medication adherence was defined as patients reporting to take their prescribed medication “All the time” or “Nearly all the time” (Table 1). Controlled hypertension was defined as BP lower than the recommended level by clinical guidelines available at the time of the study (140/90mmHg, 140/85mmHg in diabetic patients) (15), during physical examination of the patient (Table 1). We considered that patients undertook behavioral changes if they reported to have taken
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