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The incidence of hypertension in Bulgaria is above the European average, reported doctors from the Bulgarian Hypertension League in connection with the 17^th of May, when the world observed World Day of the Sick. According to experts, the country’s hypertension rate is around 55% while the average for Europe is 30-45%. Physicians’ data indicates that only 37% of the patients with this disease are treated adequately.

Arterial hypertension (AH) is identified as the leading global risk for mortality, responsible for 9.4 million deaths worldwide. Every third person in the world suffers from high blood pressure, and only one of the three is treated effectively.

Hypertension significantly increases the risk of micro and macrovascular complications, doubling the total mortality and the incidence of stroke, tripling the likelihood of coronary heart disease (CHD) and accelerating the progression of diabetic nephropathy, retinopathy and neuropathy.

The adequate treatment of AH prolongs life. The decrease in systolic blood pressure by 12 mm/Hg for 10 years saves from death 1 in 11 treated patients and decreases the frequency of stroke by 35-40%, of myocardial infarction – by 20-25%, and of heart failure – by 50%.

Arterial hypertension is often part of a combination of anthropometric and metabolic disorders, including abdominal obesity, dyslipidemia (abnormal lipid profile), high blood sugar, etc., defined as “metabolic syndrome” (MetS). Obesity is the risk factor №1 for hypertension. Therefore, the Bulgarian Hypertension League has selected the metabolic syndrome components to be the focus in the national information campaign dedicated to the World Hypertension Day 2015, which passed under the motto “Healthy weight – healthy blood pressure.”

Already in 2002, the World Health Organization alerted that the global epidemic cardiovascular disease increase is associated with an increase in the number of overweight and obese people. Over 1 billion people worldwide are overweight, 400 million of them – are obese. Obesity is a growing problem among adolescents. It is reported that 1 in 6 children in the world is overweight, and in the US – 1 of 3.

According to the Bulgarian Society of Endocrinology, 34.93% of the population in Bulgaria is obese, and 38.95% – overweight. This means that every second Bulgarian man (45%) and every third Bulgarian woman (32.4%) between 30-60 years is overweight. More alarming is the fact that 40% of Bulgarian children (21.9% of the boys and 17.7% of the girls of 5-17 years) are also overweight or obese. This identifies not only an aesthetic problem, but a problem of poor health, of risk for a number of serious diseases that threaten life quality and life expectancy. The close link between some cardiovascular diseases and obesity defines the group of “obesity-related cardiovascular diseases.” These are arterial hypertension, atherosclerosis, heart failure, atrial fibrillation, stroke, sleep apnea, and peripheral venous disease.

Being overweight is one of the strongest predictors of hypertension. Hypertension is about 6 times more frequent in obese people than in those with normal weight. The incidence of hypertension increases with the unidirectional growth of the body mass index (BMI = weight/kg divided by the height in m²).

When the BMI is below 25 kg/m² (the norm) the incidence of hypertension is about 15%. When the BMI is over 25 kg/m², the incidence of hypertension is 38% – in men and 42% – in women. When the BMI is over 30 kg/m² the risk of stroke increases by 32%. There is a close connection between abdominal obesity and arterial hypertension. The centimeters of the waist circumference, which carry an increased cardiovascular risk, are over 102 cm for men, and 88 cm – for women.

Weight reduction through a low calorie diet and increased physical activity can affect obesity and this is what is recommended as the first and most significant step in the body weight reduction therapeutic approach, and hence as the first measure to reduce cardiovascular risk, to prevent and/or treat diabetes mellitus type 2. Body weight reduction leads to blood pressure reduction. Weight reduction by 10 kg results in a decrease in systolic blood pressure by 5 to 20 mm/Hg, and also improves the medication response.

Since coming into office, the government has appointed 70 doctors and 77 nurses in emergency assistance, said the Health Minister Dr. Peter Moscow in Veliko Tarnovo, noting that emergency assistance is a priority in the healthcare reform.

According to him, the reason for appointing new employees was that the government very quickly had been able to create financial and economic prerequisites for specialists to want to work in the emergency centers again. “For the same period, the country provided 56 ambulances and 14 centers were equipped with devices for telemedicine. This is expensive and advanced equipment, which allows quick telecommunication. Together with Prime Minister Borisov and Minister Pavlova, we will be able to ensure additional €85 million for emergency assistance. With this sum, we will renew the entire vehicle fleet and equip all emergency departments,” said the Minister.

The aim is that 7 million Bulgarians across the country have access to emergency assistance within 30 minutes by the end the mandate, he explained and clarified that two helicopters will be provided for the purpose.
The Health Minister also informed that through transatlantic cooperation with Romania we are expecting even more EU funding.

People with cancer, mental health and chronic skin diseases will be receiving all necessary therapies, diagnostics, medicines and procedures in one place – a large hospital in the area.

The Health Ministry will be closing the dispensaries for the respective diseases and they will merge with general hospitals, confirmed the Health Minister Dr. Petar Moskov in front of the Parliamentary Health Committee. This will be done through amendments to the Medical Institutions Act, discussed by the Committee. Among the reasons was mentioned the duplication of structures and activities in dispensaries and hospitals, making the existence of the current oncology centers, mental and skin disorders “pointless”.

The merger aims patients to receive combined services in one place, and not to be sent for everything to different structures, explained Dr. Moskov. He described the situation of the patient as “a small animal in the jungle among the predators, where there is no way for him.” The liquidation of dispensaries is also a recommendation of the World Bank, said the Deputy Minister Dr. Vanyo Sharkov.

The intention of the Health Ministry created tensions among dispensary patients. “The monitoring of these patients continues for life. In a merger of oncology centers with general hospitals – who will be committed to this long term? The creation of large structures will worsen and commercialize the treatment of patients,” said Dr. Parashkev Tsvetkov, a surgeon in the Plovdiv Oncological Dispensary.

The Oncology Clinic in Blagoevgrad took part in protest demonstrations last week. Doctors from the hospital “St. Mina” were supported by the Mayor Dr. Atanas Kambitov and the President of the Municipal Council Radoslav Taskov. “We do not agree with the proposals of the Minister. As a physician and a mayor, I am against the amendments to the Medical Institutions Act. The Oncology Hospital is municipal 100%. The municipality has invested in it BGN 1 million – separately from the operational programs. The changes will not improve the treatment quality,” explained Mayor Kambitov. “There is no way to legislate changes so that municipal property becomes state property without the decision of the Municipal Council, and there has been no such decision,” specified Taskov.

“This is a good step by the Health Ministry, as most clinics in the country are hollow structures. However, there is a real problem with the property – in most cases the dispensaries are municipal and cannot be transferred into state structures,” explained Prof. Valentin Ignatov, Head of the Association of University Hospitals.

The idea of the Health Ministry regarding the merger of dispensaries and hospitals is to take place within a year.

Hospitals will receive nearly BGN 15.2 million more by the end of the year, informed reporters the member of the Supervisory Board of the NHIF Dr. Vanyo Sharkov last Wednesday. He explained that the Supervisory Board at a meeting has made a decision the university hospitals budgets to be increased by 2%, while the budgets of all others who provide emergency services – by 1%. A day later it became clear that in addition to the initially announced 146 hospitals, which will receive more funding, over 70 more hospitals have submitted applications. The money will be deducted from the reserve of the NHIF.

“It all is based on the decision and what we proposed at the previous meeting – to increase the budgets for providing emergency medical care. The operational management of the NHIF provided the lists and the distribution was carried out accordingly. What the operational leadership offered, we have adopted,” said the member of the Supervisory Board.

Dr. Sharkov said that “Pirogov Hospital” will receive most additional resources – about BGN 1 million. “University hospitals and hospitals with emergency consultation wards include: ‘Aleksandrovska Hospital’, ’Pirogov Hospital’, The Military Medical Academy, The Medical Institute of the Interior ‘St. George’, and ‘St. Marina’, “ he replied to the question which hospitals come after “Pirogov Hospital”.

The Director of the NHIF Dr. Glinka Komitov noted that the operational management of the Fund will offer additional funding only to hospitals with motivated demands. According to his forecast, in order to satisfy the demands of these hospitals, about BGN 50 million would be needed. Realistically, however, the allocated amount would be much less, said the Director of the NHIF.
The Supervisory Board of the institution is expected to examine these proposals on May 25^th.

The Health Minister takes on the medicine procurement in hospitals, announced the Council of Ministers in its Draft Decree. It was published on the website of the Ministry of Health for public comment.

In his new activity, the Minister will be assisted by a new unit in the Department, which will be created for the occasion – the “Central Unit for Negotiation and Administration.”

As a central authority, responsible for procurement in the “Healthcare” sector, the Minister will plan, prepare and carry out medicine procurement procedures. He will also be concluding framework agreements on behalf of hospitals.

Based on the concluded framework agreements, hospitals will determine the contractor using electronic auction and will conclude individual agreements, envisages the document.

The Minister will have the power to supervise the implementation of the framework agreements in relation to their compliance with their conditions – prices, quantities, deadlines and more.

The project also includes the possibility, if necessary, the Health Minister to conduct procedures to conclude the framework agreement on behalf of hospitals, through electronic auction.

One year after the Decree comes into force, the Health Minister has to provide conditions for conducting an auction through an integrated information system – an online platform for e-commerce needs of hospitals – indicates the text.

Until the conclusion of the framework agreement under this Decree, the medical institutions will provide their medications under the previous order, and the existing framework agreements and contracts with the same subject, concluded by hospitals’ management, will retain their validity for the period for which they have been concluded, except if terminated before the expiry of their term, it becomes clear from the draft document.

The change will result in time savings, administrative and financial resources for the hospitals and will reduce drug prices, are the motives of the Health Ministry. Furthermore, the reorganization will enable a faster and better response to the needs of hospitals, the presence of stable contracts and easing the system responsible for appeal procedures, according to the Department. According to them, the introduction of e-procurement will also facilitate the participation of all wholesalers, who are listed in the register for holding an authorization for medicines wholesale, and will increase the competition and improve the contracting sector conditions.

The extended use of electronic means and resources and the integration of the platform with the existing electronic records will contribute to the full publicity and transparency to effectively confront and prevent corruption in the sector, is said in a statement.