title: Improving hypertension control among excessive alcohol drinkers: a randomised controlled trial in France. The WALPA Group.
abstract: OBJECTIVE
  To improve blood pressure control among hypertensive ( > 140/90 mmHg) excessive alcohol drinkers.
  
  
  METHODS
  Fourteen worksite physicians were randomised onto an intervention group and a control group. The intervention was based on training the worksite physicians and follow up of those hypertensive subjects defined as excessive drinkers. Follow up was based on self monitoring of alcohol consumption by the subject, in view of the results of their gamma glutamyl transferase (GGT) activity determination.
  
  
  METHODS
  Fourteen workplaces in France - mainly in the industrial sector.
  
  
  METHODS
  Altogether 15 301 subjects were screened by the 14 physicians: 129 of these were included in the study.
  
  
  METHODS
  This was the difference between the initial systolic blood pressure (SBP) and the SBP one year later (delta BP). Secondary criteria were the difference between the initial and final diastolic blood pressure (delta DBP) and delta BP at two years; antihypertensive treatment; state alcohol consumption (delta AC); delta GGT; and body mass index (delta BMI).
  
  
  RESULTS
  The decrease in SBP levels was significantly larger in the intervention group than in the control group: at one year, delta SBP values were -11.9 (15.6) mmHg and -4.6 (13.8) respectively (p < 0.05). This benefit was still observed after two years of follow up (-13.8 (17.4) mmHg v -7.5 (14.2) mmHg (p < 0.05)). No difference was observed in DBP. The percentage of treated subjects did not differ between groups. At one year, delta AC was larger in the intervention group (-2.8 (5.2) U/d) than in the control group (-1.6 (3.4) (p < 0.1)). delta GGT and delta BMI did not differ between the two groups. A weak positive correlation was observed between delta AC and delta SBP (r = 0.16).
  
  
  CONCLUSIONS
  An intervention aimed at the hypertensive excessive drinkers in a working population was found to be effective in reducing SBP on a long term basis (two years). The mechanisms of reduction in alcohol consumption and improved drug compliance cannot be ascertained in this pragmatic study. From a public health point of view, reducing the excess cardiovascular risk among a "hard to reach" population seems feasible with a strategy specifically designed for this high risk group.
authors.affiliation: INSERM U258, Hôpital Broussais, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Lang
authors.forename: V
authors.initials: V
authors.lastname: Nicaud
authors.forename: B
authors.initials: B
authors.lastname: Darné
authors.forename: B
authors.initials: B
authors.lastname: Rueff
mesh_terms: D000041:Absenteeism; D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control*; D001795:Blood Pressure Determination; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000517:prevention & control*; D007221:Industry; D008297:Male; D005723:gamma-Glutamyltransferase / Q000032:analysis
chemical_list: D005723:gamma-Glutamyltransferase