Effects of a long-term hypertension control program on stroke incidence and prevalence in a rural community in northeastern Japan.
OBJECTIVE
Although randomized clinical trials have demonstrated the benefit of antihypertensive treatment in preventing stroke, the effectiveness of community-based programs is largely unknown. We investigated long-term community-based prevention activities.


METHODS
In rural northeastern Japan, people aged > or = 30 years numbered 3219 in the full intervention community and 1468 in the minimal intervention community in 1965. Systematic blood pressure screening and health education began in 1963. Stroke was registered through 1987.


RESULTS
More than 80% of people aged 40 to 69 years were screened in both communities in the 1960s. One community charged for screening services after 1968, whereas the other community intensified intervention; subsequently, screening rates and the follow-up of hypertensive individuals declined in the minimal intervention community, especially in men. In men, stroke incidence declined more (P < 0.001) in the full intervention (42% in the period 1970 to 1975, 53% in the period 1976 to 1981, and 75% in the period 1982 to 1987) than in the minimal intervention community (5% increase, 20% decrease, and 29% decrease, respectively); in women, the stroke incidence declined about 45% to 65% in both communities. Changes in stroke prevalence paralleled those in stroke incidence. Trends in systolic blood pressure levels tend to explain the differential stroke rates in men.


CONCLUSIONS
Delivery of hypertension control services through intensive, free, community-wide screening and health education was effective in prevention of stroke for men in a community.
Institute of Community Medicine, University of Tsukuba, Ibaraki-ken, Japan.
H
H
Iso
T
T
Shimamoto
Y
Y
Naito
S
S
Sato
A
A
Kitamura
M
M
Iida
M
M
Konishi
D R
DR
Jacobs
Y
Y
Komachi
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002561:Cerebrovascular Disorders / Q000453:epidemiology*; D003153:Community Health Services / Q000458:organization & administration; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D015397:Program Evaluation; D012307:Risk Factors; D019035:Rural Health Services / Q000458:organization & administration; D012424:Rural Population; D017678:Sex Distribution
D000959:Antihypertensive Agents