Abstract
Objectives
Coronary artery disease (CAD) is a leading cause of mortality and morbidity worldwide, and hypertension (HT) is a chronic condition characterized by high blood pressure. Early diagnosis and treatment are the most important goals in CAD and HT. The SCORE2 estimates 10-year risk of fatal and non-fatal cardiovascular events. Although the number of patients receiving treatment for HT and CAD has increased in recent years, awareness of these diseases has not yet reached satisfactory levels. We aimed to assess awareness of HT and CAD among healthcare professionals.
Materials and Methods
The study covered topics related to HT awareness, cardiovascular disease (CVD) prevention, diet, nutritional habits, and lifestyle. Blood pressure was measured with a standard, calibrated sphygmomanometer after participants rested for at least 5 minutes and was repeated 10 minutes after the survey. Cardiovascular risk scores were calculated using SCORE2.
Results
Among the 169 healthcare professionals included in the study, 40.2% (68) were male, and 59.8% (101) were female. The median age was 40 years. 13.6% of healthcare professionals had a diagnosis of HT. The rate of newly diagnosed HT was found to be 4.1%. The median SCORE2 was 2.4 in the night-shift group and 1.7 in the non-night-shift group (p=0.024).
Conclusion
Regular blood pressure measurement among healthcare professionals was insufficient. While shift work does not increase CVD risk, this finding is thought to be due to the younger age of healthcare professionals who perform it.
Introduction
Hypertension (HT) is considered one of the most common and preventable risk factors for cardiovascular diseases (CVD) and related mortality(1, 2). According to World Health Organization 2024 data, approximately 36.9% of individuals living in Europe are diagnosed with HT(3). Epidemiological studies conducted in Türkiye have determined the prevalence of HT to be 31.8%, with only 40.7% of individuals reported to be aware of the disease and 31.1% receiving treatment(4, 5). In a study conducted on healthcare workers in Türkiye, the prevalence of HT was reported as 14.8%(6).
CAD is a leading cause of mortality and morbidity in Türkiye and worldwide. Early diagnosis, treatment, and cardiac rehabilitation are the most important goals in CAD(7). To estimate the 10-year fatal and non-fatal CV risk, SCORE2 is recommended for patients aged 40–69 years, and SCORE2-OP for those aged ≥70 years(8-10). The SCORE2 risk calculation is based on age, gender, systolic blood pressure (BP), total cholesterol, high-density lipoprotein (HDL) cholesterol, smoking status, and regional cardiovascular mortality data(9, 10). The guidelines recommend calculating SCORE2/SCORE2-OP for the management of HT in patients with high BP, and antihypertensive treatment is recommended for patients with a SCORE2 ≥10%(2, 8). According to Global Burden data, risk areas are divided into four categories: low, moderate, high, and very high risk. Türkiye is included in the high-risk area in this classification(11).
Despite their medical background, healthcare professionals frequently face high occupational stress, irregular working hours, and lifestyle constraints, which can paradoxically increase their vulnerability to chronic conditions and lead to lower adherence to personal preventive health behaviors. Healthcare workers serve a pivotal role not only in managing public health but also in acting as role models for their patients; therefore, assessing their personal awareness and control regarding major cardiovascular risk factors and HT n is of paramount clinical importance(12, 13).
Although the proportion of patients receiving treatment for HT and CAD has increased in recent years, awareness of these diseases has not yet reached the desired level. Our study aimed to assess healthcare professionals’ awareness of HT and CAD and to determine the prevalence of HT and of CV risk profiles.
Materials and Methods
This study is a descriptive and analytical cross-sectional study involving healthcare professionals working at Dokuz Eylül University Hospital. Prior to the study, the necessary ethical approval was obtained from the Dokuz Eylül University Ethics Committee (decision no: 2025/08-13). The study was conducted among healthcare professionals between 06/03/2025 and 30/06/2025. Written informed consent was obtained from all participants in accordance with ethical standards. The 17-question survey was designed to assess HT awareness, CV protection, dietary and nutritional habits, lifestyle behaviors, and knowledge of coronary artery disease.
Blood Pressure Evaluation Protocol
Systemic BP evaluations were carried out in strict accordance with the contemporary recommendations of the European Society of Cardiology and the European Society of Hypertension. Data collection took place within a quiet, climate-regulated setting. Following completion of the questionnaire and after a minimum five-minute stabilization period, participants were maintained in a relaxed seated posture with adequate lumbar support and uncrossed lower extremities. Prior to evaluation, individuals refrained from physical exertion, caffeine ingestion, and tobacco use for at least half an hour, with urinary bladder evacuation ensured when clinically indicated(8).
The examined upper extremity was carefully supported at heart level to prevent pressure increases induced by isometric contraction, and clothing over the cuff application site was removed to avoid a tourniquet effect from rolled-up sleeves. Measurements were performed using a standard, calibrated automated oscillometric device (Omron M2 Basic HEM-7121J-E) with appropriately sized cuffs. The inferior border of the cuff was secured a few centimeters proximal to the antecubital crease to avoid placing the stethoscope beneath the cuff.
During the measurements, at least two measurements were taken with at least two minutes between each reading, and the average of the obtained values was recorded for analysis(8).
In the study, HT was diagnosed based on the 2024 ESC Guidelines for the Management of High Blood Pressure and Hypertension, using the criterion of systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, confirmed by the average of consecutive measurements taken at least two minutes apart. Furthermore, the SCORE2 score was calculated for CV risk classification in individuals over 40 years of age using data on gender, age, smoking status, systolic BP, total cholesterol, HDL cholesterol, and regional CV mortality(8-10).
Statistical Analysis
The obtained data were analyzed using SPSS 29.0. Descriptive data were reported as numbers and percentages (%) for categorical variables and as mean ± standard deviation or median (interquartile range: 25th–75th percentile) for continuous variables. The distribution of continuous variables was assessed using the Kolmogorov-Smirnov and/or Shapiro-Wilk tests; comparisons were made of normally distributed data using Student’s t-test. Correlations between categorical variables were analyzed using the Pearson chi-square test. Fisher’s exact test was used when the necessary assumptions were not met. In all statistical analyses, a two-sided p<0.05 was considered the significance threshold.
Results
A total of 169 healthcare professionals were included in our study, and analysis of the demographic characteristics revealed that 40.2% (n=68) were male and 59.8% (n=101) were female. The median age was 40 years, and the median body mass index was 26.5 kg/m2. Detailed data on the participants’ demographic characteristics are provided in Table 1.
13.6% (n=23) of the healthcare professionals were previously diagnosed with HT. Based on standard BP measurements taken before and 10 minutes after the survey, 4.1% (n=7) of participants were newly diagnosed with HT. The rate of participants diagnosed with diabetes mellitus was 1.8% (n=3). The majority of the participants were nurses (27.8%, n=47. Among other occupational groups, 26% (n=44) worked as cleaning personnel, 17.2% (n=29) as physicians, and 18.9% (n=32) as medical secretaries; additionally, 66.3% (n=112) of healthcare workers actively worked shifts (Table 1).
The majority of participants (48.5%) preferred a Mediterranean diet, which emphasizes vegetables. One of the striking findings of the study was that 92.3% (n=156) of participants reported believing their home BP was within the normal range; however, only 24.3% (n=41) reported regularly monitoring their BP. The proportion of participants with daily salt consumption above 5–6 grams was 39.6% (n=67). The responses to the 17 survey questions directed at healthcare professionals are presented in Tables 2 and 3.
A history of CAD was present in the first-degree relatives of 33.7% of participants (n=57). The prevalence of smoking and alcohol consumption among healthcare workers were 37.3% and 40.8%, respectively. When the participants’ lipid profiles were examined, the median low-density lipoprotein (LDL) cholesterol level was 124 mg/dL. Additionally, the SCORE2 risk assessment was used to determine the 10-year CVD risk in individuals aged 40 and older. In the analysis of data from 79 participants in this age group, the median SCORE2 was 1.9. The findings are detailed in Table 3. This group comprised shift workers (n=49) and non-shift workers (n=30) (Table 4). The median age of the shift group was 37, while that of the non-shift group was 44; this difference was statistically significant (p=0.0159). No statistically significant differences were found between the two groups for the other parameters.
The median SCORE2 value was 2.4 in the non-shift group and 1.7 in the shift group; the difference was statistically significant (p=0.024) (Table 4).
Discussion
The study covered topics related to CV risk, HT awareness, CVD prevention, nutritional habits, and lifestyle. The rate of regular BP measurements among healthcare professionals is low. New cases of HT were identified in 4% of healthcare workers, even though they worked in a hospital environment. One of the striking findings of the study was that 92.3% (n=156) of participants stated that they believed their home BP was within the normal range; however, only 24.3% (n=41) reported regularly monitoring their BP.
According to the ESC 2021 CVD Prevention Guidelines, following a Mediterranean-type or equivalent diet, replacing saturated fats with unsaturated fats, and reducing salt intake are strongly recommended for the prevention of CVD, with a Class I recommendation(14). The majority of healthcare workers (48.5%) adhere to a diet primarily focused on vegetables, similar to a Mediterranean-type diet. While the alcohol consumption rate in Türkiye as of 2023 was reported to be 10.2%(15), our study determined that the alcohol consumption rate among healthcare workers was quite high, reaching 40.82%. Especially among individuals under 50 years, the risk of CVD is approximately five times higher in smokers compared to non-smokers(16, 17). While the smoking rate in Türkiye was reported to be 34.8% in 2023(15), our study found that this rate was slightly higher among healthcare workers, reaching 37.3%.
Results from randomized controlled trials show that lowering LDL levels safely reduces the risk of CVD even at low levels(18, 19). Current literature clearly demonstrates that low HDL levels (<30–35 mg/dL) increase the risk of atherosclerotic CVD; it has also been shown that very high HDL levels (>90 mg/dL) may be paradoxically associated with an increased risk(20, 21). In a study conducted among nurses working in a hospital, the median LDL level was reported as 114.02 mg/dL, the HDL level as 55.86 mg/dL, and the total cholesterol level as 189.63 mg/dL(22). Similarly, in our study, when evaluating the lipid profiles of healthcare workers, the median LDL was 124 mg/dL, HDL was 54.7 mg/dL, and total cholesterol was
207 mg/dL.
According to the SCORE2 risk score, if the 10-year fatal and non-fatal CV disease risk is below 2.5%, it is defined as low to moderate CV risk, if it is between 2.5% and <7.5%, it is defined as high CV risk, and if it is ≥7.5%, it is defined as very high CV risk(8-10). In our study, SCORE2 was calculated for CV risk assessment in 79 participants over the age of 40. The median SCORE2 value was 1.9, indicating that the participants were generally in the low-to-moderate risk group. In strict accordance with the current European Society of Cardiology (ESC) guidelines, SCORE2 and SCORE2-OP calculations were restricted to participants aged 40 years and older, as these risk-estimation models are specifically calibrated and validated for individuals aged 40–69 years and ≥70 years, respectively. Applying this algorithm to younger cohorts is not clinically recommended since 10-year short-term risk calculations are not designed for individuals under 40, in whom lifetime cardiovascular risk remains the primary consideration(8-10). The observed low SCORE2 values in our cohort primarily reflect the age distribution and demographic profile of the participating healthcare professionals. Although short-term calculated risks appear low, contemporary guidelines emphasize that early identification and management of modifiable risk factors, such as BP control and lifestyle modifications, remain essential to mitigate cumulative lifetime cardiovascular burden in professional populations. In this study, the median age of the shift group is younger than that of the non-shift group. The median SCORE2 value was 2.4 in the non-shift group and 1.7 in the shift group, and the difference was statistically significant (p=0.024). These findings indicate that shift work in hospitals does not have a significant effect on the CV risk profile; however, this may be related to the younger age of individuals working shifts.
Study Limitations
Limitations of this study include its single-center design, relatively small total sample size (n=169), and the limited number of participants over the age of 40 included in the SCORE2 risk calculations (n=79). Due to these methodological constraints and the single-center setting, the findings cannot be fully generalized to all healthcare professionals across different institutions or broader healthcare systems; therefore, the results should be interpreted within this specific context. Additionally, several parameters, including daily salt consumption, dietary habits, and perceptions of home BP measurements, were obtained via questionnaires, which inherently limits the ability to rely solely on self-reported information. Despite these limitations, this study provides preliminary and clinically relevant data on HT awareness and cardiovascular risk profiles among healthcare professionals.
Conclusion
The rate of regular BP measurement among healthcare workers is low. The rate of newly diagnosed HT was 4.1%. In this cohort, shift work was not associated with a higher SCORE2-estimated cardiovascular risk; however, this finding should be interpreted cautiously because shift workers were significantly younger than non-shift workers. Healthcare workers have higher rates of smoking and alcohol use than the general population.
