Effectiveness of treatment with antihypertensive drugs and trends in mortality from stroke in the community.

Tuomilehto, Jaakko; Nissinen, Aulikki; Wolf, Eva; Geboers, J.; Piha, T; Puska, Pekka

doi:10.1136/bmj.291.6499.857

Cited by 28 publications

(4 citation statements)

References 23 publications

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“…20 In addition, a temporal concordance between rates of hypertension control and stroke mortality has been noted for both male and female residents of North Karelia and Kuopio County, Finland. 6 Our analyses do not support an association between trends in treatment and control of hypertension and rates of decline in stroke mortality, primarily because the rates of decline did not vary much after adjustment for age-related differences in the magnitude of stroke mortality. Thus, the proportionate rates of decline were approximately equal among all age-race-sex groups.…”

Section: -R-contrasting

confidence: 42%

Decline in US stroke mortality. Demographic trends and antihypertensive treatment.

Klag

Seidler

1989

Stroke

114

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Stroke mortality has been falling rapidly in this country since 1973. To investigate age-race-sex effects on stroke mortality, we studied US vital statistics during 1950-1972 and 1973-1981 in 55-64-, 65-74-, and 75-84-year-old race-sex groups. The accelerated rate of decline in stroke mortality since 1973 has had a substantial public health impact, with >200,000 fewer stroke deaths than would otherwise have occurred. For all groups, stroke mortality declined at a greater rate (/?<0.05) in 1973-1981 than during 1950-1972. The rates of decline during 1973-1981 were greater with increasing age (/?<0.05) and were more substantial for younger blacks. There were no consistent differences in the rate of decline by sex. The greater rate of decline hi absolute stroke mortality in the older age groups and blacks was explained by higher baseline mortality in these groups. Overall This recent downturn in mortality has been seen in most Western nations 3 and has been attributed to improved treatment and control of hypertension. 24 -7 Despite these favorable trends, stroke remains the third leading cause of death and stroke-associated morbidity and mortality are important public health problems. 8 The notion that the accelerated decline in stroke mortality has resulted from increased use of antihypertensive drug therapy in the general community is certainly plausible. However, little evidence has been generated to document the validity of this putative association. Received May 11, 1988; accepted August 3, 1988. In three US national surveys performed during the period of accelerated decline in stroke mortality, consistent techniques have been used to gather information regarding the prevalence of treatment and control of hypertension in the general community. 9 With this in mind, we decided to explore the public health implications of the recent accelerated decline in US stroke mortality and to identify the relation between the decline and national trends in the prevalence of treatment and control of hypertension. Specifically, we set out to 1) estimate the reduction in deaths attributable to the accelerated decline, 2) determine how the accelerated decline varied by age, race, and sex, and 3) determine if the prevalence of hypertension therapy among various age-race-sex groups was associated with the decline in the rate of stroke mortality. Subjects and MethodsRace-and sex-specific stroke mortality for 1950-1981 was obtained for the 55-64-, 65-74-, and 75-84-year-old age groups from US vital statistics data.10 Because mortality for blacks was not available for the entire study period, death rates for nonwhites were used. To provide a period during which the prevalence of antihypertensive drug therapy varied considerably, we studied temporal trends in stroke mortality between 1950 and 1981. Thiazide diuretics were introduced in 1958, but antihypertenby guest on May 11, 2018 http://stroke.ahajournals.org/ Downloaded from

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Section: -R-contrasting

confidence: 42%

Decline in US stroke mortality. Demographic trends and antihypertensive treatment.

Klag

Seidler

1989

Stroke

114

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“…We attribute the success of this community program to active participation of existing health resources in the detection and control of hypertension and to consistently high participation in blood pressure screenings, follow-up examinations, and community-wide health education activities. A mix of public health screening, media-based messages and education, and community involvement and activities is widely used in the United States 10,32 and Finland 7,11 to combat cardiovascular disease. Enhancements in these methods did not lead to accelerated disease reduction in Minnesota, 12 although acceleration in the decline in ischemic heart disease mortality occurred in Finland.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10] However, none of these community trials, primarily designed for prevention of coronary heart disease, have demonstrated reduced stroke rates. 11,12 Japan suffers higher mortality from stroke and lower mortality from coronary heart disease than Western countries. 13 To ameliorate the epidemic of stroke, communitybased programs of hypertension control were launched in Japan in the 1960s, including those we implemented in 1963 in 2 agricultural communities in northeastern Japan.…”

mentioning

confidence: 99%

Effects of a Long-term Hypertension Control Program on Stroke Incidence and Prevalence in a Rural Community in Northeastern Japan

Iso

Satō

Naito

et al. 1998

Stroke

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Background and Purpose-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 Ն30 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 (PϽ0.001) 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. (Stroke. 1998;29:1510-1518.)

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“…Indeed, the ob served decline in case fatality in North Ca rolina was sufficiently large to explain the total decline in mortality, even with no change in the incidence rate. In reports from other countries, Tuomilehto et al [16] sup ported the hypertension control decreasing incidence hypothesis in a Finnish popula tion, while Bonita and Beaglehole [17] esti mated that control of hypertension ac counted for only about 10% of the decline in stroke mortality in New Zealand.…”

Section: Introductionmentioning

confidence: 99%

Relationship of Hospitalized Stroke Rate and In-Hospital Mortality to the Decline in US Stroke Mortality

Howard¹,

Craven²,

Sanders³

et al. 1991

Neuroepidemiology

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Data from the National Hospital Discharge Survey was used to estimate the admission rate and in-hospital mortality for US stroke patients from 1970 to 1987. Over this period the hospital admission rate increased from 5.0 per 1,000 population to 5.5 per 1,000, while the in-hospital mortality fell from 18.6 to 10.0% of discharges. When patients experiencing general or late effects or transient ischemic attacks were excluded, the hospital admission rate increased from 2.8 to 4.8 per 1,000 and in-hospital mortality fell from 26 to 12% of discharges. Admission rates increased from 1970 to 1987 for both hemorrhagic strokes and cerebral infarctions, but fell for ill-defined cerebrovascular events, presumably reflecting increased use of computed tomography and magnetic resonance imaging during this period. Mortality for hemorrhagic strokes decreased from 45 to 30% of discharges, mortality for infarctions decreased from 24 to 13 % and mortality for ill-defined events fell from 24 to 17%. There are several limitations with the use of the National Hospital Discharge Survey data to estimate changes in hospital admission rates and in-hospital mortality. However, these data suggest a greater role for decreasing case fatality in explaining nationwide declines in stroke mortality rates than has generally been acknowledged.

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Effectiveness of treatment with antihypertensive drugs and trends in mortality from stroke in the community.

Cited by 28 publications

References 23 publications

Decline in US stroke mortality. Demographic trends and antihypertensive treatment.

Decline in US stroke mortality. Demographic trends and antihypertensive treatment.

Effects of a Long-term Hypertension Control Program on Stroke Incidence and Prevalence in a Rural Community in Northeastern Japan

Relationship of Hospitalized Stroke Rate and In-Hospital Mortality to the Decline in US Stroke Mortality

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