title: Blood pressure response to a community-based program and long-term cardiovascular outcome.
abstract: BACKGROUND
  The significance in terms of the cardiovascular outcome of different patterns of blood pressure (BP) response to community-based activities has not been previously studied. The aim of our study was to evaluate the relationship between changes of BP observed during a community-based program and long-term rate of cardiovascular disease (CVD) events.
  
  
  METHODS
  A program focused on the prevention of CVDs was implemented in a small city in Argentina over a 6-year period (1997-2003). The program was evaluated using a cohort of 1,526 randomly selected individuals. The population's mean systolic BP (SBP) decreased approximately 5mm Hg, but BP changes were heterogeneous. Eight years after the intervention had stopped, 1,124 individuals of the cohort were surveyed to evaluate incident CVD events. The sample was divided into 3 SBP change categories during the intervention: decrease (< -5mm Hg), no change (-5 to 5mm Hg) and increase (> 5mm Hg). Cox models were used to estimate the hazard ratio (HR) of CVD events for each category adjusted for age, sex, and baseline BP.
  
  
  RESULTS
  At the end of the intervention, individuals who had increased their SBP showed an adjusted HR for CVD that was double those whose SBP levels decreased or did not change. An inverse relationship between baseline SBP and ΔSBP was observed: individuals with an increase in BP during the intervention had lower SBP at the beginning of the study.
  
  
  CONCLUSIONS
  BP increase during the community-based program was an independent predictor of CVD events.
authors.affiliation: Hospital Universitario San Martín, La Plata, Buenos Aires, Argentina; salazarlandea@gmail.com.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Salazar
authors.affiliation: Hospital Universitario San Martín, La Plata, Buenos Aires, Argentina;
authors.forename: Walter G
authors.initials: WG
authors.lastname: Espeche
authors.affiliation: Hospital Municipal, Rauch city, Buenos Aires, Argentina.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Aizpurúa
authors.affiliation: Hospital Universitario San Martín, La Plata, Buenos Aires, Argentina;
authors.forename: Betty C
authors.initials: BC
authors.lastname: Leiva Sisnieguez
authors.affiliation: Hospital Universitario San Martín, La Plata, Buenos Aires, Argentina;
authors.forename: Eduardo
authors.initials: E
authors.lastname: Balbín
authors.affiliation: Hospital Universitario San Martín, La Plata, Buenos Aires, Argentina;
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Dulbecco
authors.affiliation: Hospital Universitario San Martín, La Plata, Buenos Aires, Argentina;
authors.forename: Horacio A
authors.initials: HA
authors.lastname: Carbajal
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001118:Argentina; D001794:Blood Pressure / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D015331:Cohort Studies; D003153:Community Health Services; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: blood pressure; cardiovascular diseases; community-based programs; health promotion; hypertension; intervention studies; public health