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Impact of the high-risk and mass strategies on hypertension control and stroke mortality in primary health care

Journal of Human Hypertension volume 18, pages 97–105 (2004)Cite this article

Abstract

Stroke has been the second leading cause of death in Taiwan in recent years. Following a 6-month pilot study in Yu-Chi in 1993, a 3.5-year hypertension control programme was performed to examine the effectiveness of combined high-risk and mass strategies in a rural community with limited medical resources. All Yu-Chi residents aged 40 years and older were invited to participate in the programme. The high-risk strategies included hypertension screening, home visits, and follow-up for the hypertensives. The mass strategies included health education and village-based campaigns. Changes over time in the participants' hypertension knowledge, behaviour, and blood pressure control status were evaluated. A comparison of the stroke mortality between the intervention community and a neighbourhood reference community before and after the intervention programme was performed. A total of 4977 residents were screened and 3761 completed the first and second rescreening. The hypertension knowledge and behaviour scores in the hypertensives significantly improved, systolic and diastolic blood pressure and waist-to-hip ratio significantly reduced, and the rates of hypertension treatment and control increased significantly at 1 and 3.5 years after intervention. In contrast, blood pressure levels increased significantly in the normotensives. Between 1994 and 1997, stroke mortality rate decreased by 39.9 and 4.8% in the intervention and reference communities, respectively. The results indicated that the community-based hypertension control programme was effective. The immediate decline in stroke mortality appeared to be mostly related to the high-risk strategies.

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References

  1. Taiwan Provincial Department of Health. Vital Statistics. Taiwan Provincial Department of Health: Chung-Hsin village, 1997, p 34.

  2. Tseng WP . Epidemiology of hypertension among Chinese in Taiwan. J Hum Hypertens 1990; 4: 144–146.

    CAS  PubMed  Google Scholar 

  3. Pan WH et al. Prevalence, awareness, treatment and control of hypertension in Taiwan: results of Nutrition and Health Survey in Taiwan (NAHSIT) 1993–1996. J Hum Hypertens 2001; 15: 793–798.

    Article  CAS  PubMed  Google Scholar 

  4. Chou P et al. Community-based epidemiological study on hypertension in Pu-Li, Taiwan. Am J Hypertens 1992; 5: 608–615.

    Article  CAS  PubMed  Google Scholar 

  5. Petrovitch H, Curb JD, Bloom-Marcus E . Isolated systolic hypertension and risk of stroke in Japanese-American men. Stroke 1995; 26: 25–29.

    Article  CAS  PubMed  Google Scholar 

  6. Nielsen WB, Vestbo J, Jensen GB . Isolated systolic hypertension as a major risk factor for stroke and myocardial infarction and an unexploited source of cardiovascular prevention: a prospective population-based study. J Hum Hypertens 1995; 9: 175–180.

    CAS  PubMed  Google Scholar 

  7. Shimamoto T et al. Epidemiology of cerebrovascular disease: stroke epidemic in Japan. J Epidemiol 1996; 6: S43–S47.

    Article  CAS  PubMed  Google Scholar 

  8. Fang XH et al. Prevention of stroke in urban China: a community-based intervention trial. Stroke 1999; 30: 495–501.

    Article  CAS  PubMed  Google Scholar 

  9. Kotchen JM et al. Impact of a rural high blood pressure control program on hypertension control and cardiovascular disease mortality. JAMA 1986; 255: 2177–2182.

    Article  CAS  PubMed  Google Scholar 

  10. Iso H et al. Effects of a long-term hypertension control program on stroke incidence and prevalence in a rural community in northeastern Japan. Stroke 1998; 29: 1510–1518.

    Article  CAS  PubMed  Google Scholar 

  11. Record NB et al. Mortality impact of an integrated community cardiovascular health program. Am J Prev Med 2000; 19: 30–38.

    Article  CAS  PubMed  Google Scholar 

  12. Campbell NR, Chockalingam A . Prevention and control of high blood pressure: challenges and opportunities. Can Med Assoc J 1995; 152: 1969–1970.

    CAS  Google Scholar 

  13. Lin T, Chen CH, Chou P . A hypertension control programme in Yu-Chi, Taiwan: preliminary results. J Formos Med Assoc 1997; 96: 613–620.

    CAS  PubMed  Google Scholar 

  14. Croft JB et al. Waist-to-hip ratio in a biracial population: measurement, implications, and cautions for using guidelines to define high risk for cardiovascular disease. J Am Diet Assoc 1995; 95: 60–64.

    Article  CAS  PubMed  Google Scholar 

  15. D'Agostino RB et al. Stroke risk profile: adjustment for antihypertensive medication. The Framingham Study. Stroke 1994; 25: 40–43.

    Article  CAS  PubMed  Google Scholar 

  16. Gillum RF, Sempos CT . The end of the long-term decline in stroke mortality in the United States? Stroke 1997; 28: 1527–1529.

    Article  CAS  PubMed  Google Scholar 

  17. Brown RD et al. Stroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989. Stroke 1996; 27: 373–380.

    CAS  PubMed  Google Scholar 

  18. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265: 3255–3264.

  19. Dahlof B et al. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 1991; 338: 1281–1285.

    Article  CAS  PubMed  Google Scholar 

  20. Liu L et al. Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group. J Hypertens 1998; 16: 1823–1829.

    Article  CAS  PubMed  Google Scholar 

  21. Anonymous. The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157: 2413–2445.

  22. Burt VL et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991. Hypertension 1995; 26: 60–69.

    Article  CAS  PubMed  Google Scholar 

  23. Klungel OH et al. Excess stroke among hypertensive men and women attributable to undertreatment of hypertension. Stroke 1999; 30: 1312–1318.

    Article  CAS  PubMed  Google Scholar 

  24. Nothwehr F, Elmer P, Hannan P . Prevalence of health behaviours related to hypertension in three blood pressure treatment groups: the Minnesota Heart Health Programme. Prev Med 1994; 23: 362–368.

    Article  CAS  PubMed  Google Scholar 

  25. Lu TH et al. Comparison of official coders versus physician panel in assignment of underlying cause of death. J Formos Med Assoc 2001; 100: 365–369.

    CAS  PubMed  Google Scholar 

  26. Start RD et al. Evaluating the reliability of causes of death in published clinical research. BMJ 1997; 314: 271.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Erfurt JC, Foote A, Heirich MA . The cost-effectiveness of work-site wellness programs for hypertension control, weight loss, and smoking cessation. J Occup Med 1991; 33: 962–970.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Community Medicine Research Center & Institute of Public Health, National Yang-Ming University, Taipei, Taiwan

    T Lin & P Chou

  2. Department of Community Medicine, China Medical University Hospital, Taichung, Taiwan

    T Lin

  3. Division of Cardiology, Taipei Veterans General Hospital, ROC, Taiwan

    C-H Chen

Authors
  1. T Lin
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  2. C-H Chen
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  3. P Chou
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Corresponding author

Correspondence to T Lin.

Appendices

Appendix A

The eight questions directed to hypertension knowledge were:

  1. 1

    What is hypertension? (1) Blood pressure ⩾170/100 mmHg. (2) Blood pressure ⩾140/90 mmHg. (3) Blood pressure ⩾120/80 mmHg. (4) I don't know.

  2. 2

    When should hypertension be treated? (1) Visit physician regularly. (2) Feel uncomfortable. (3) Not necessary. (4) I don't know.

  3. 3

    When should antihypertensive medication be taken? (1) Feel uncomfortable. (2) According to physician's order. (3) Not necessary. (4) I don't know.

  4. 4

    What are the symptoms of hypertension? (1) No symptom. (2) Headache, dizziness, or nuchal soreness. (3) Maybe no symptom; headache, dizziness, or nuchal soreness. (4) I don't know.

  5. 5

    What are the complications of hypertension? (1) Heart disease. (2) Renal disease. (3) Stroke. (4) All of them. (5) I don't know.

  6. 6

    Prevention of hypertension should involve reduced sodium intake and low-fat dairy products. (1) Agree. (2) Not agree.

  7. 7

    Alcohol consumption and smoking do not affect blood pressure. (1) Agree. (2) Not agree.

  8. 8

    Hypertension can be cured. (1) Agree. (2) Not agree.

Appendix B

The six questions directed to the behaviour related to hypertension were:

  1. 1

    Have you had your blood pressure taken in the past 3 months? (1) Yes. (2) No.

  2. 2

    Have you seen a physician regularly in the past 3 months (only for hypertensive cases)? (1) Yes. (2) No.

  3. 3

    Have you taken antihypertensive medication regularly during the past 6 months (only for hypertensive cases)? (1) Yes. (2) No.

  4. 4

    Have you checked your body weight in the past 6 months? (1) Yes. (2) No.

  5. 5

    Do you exercise regularly (>2 times/week, >30 min/time) in the past 6 months? (1) Yes. (2) No.

  6. 6

    Have you smoked in the past 6 months? (1) Yes. (2) No.

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Lin, T., Chen, CH. & Chou, P. Impact of the high-risk and mass strategies on hypertension control and stroke mortality in primary health care. J Hum Hypertens 18, 97–105 (2004). https://doi.org/10.1038/sj.jhh.1001642

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  • DOI: https://doi.org/10.1038/sj.jhh.1001642

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