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

Abstract

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.)

Cardiovascular Disease Epidemiology in Asia

“…5 In 1999, the age-adjusted mortality from stroke for men and women was 41.6 and 42.8 per 100,000, respectively, accounting for approximately 40% decrease in stroke for men Strategies for hypertension prevention and control include annual systematic cardiovascular screening, referral of highrisk individuals to local clinics for antihypertensive medication, health education for hypertensive patients at blood pressure (BP) screening sites and during home visits by public health nurses, and community-wide media-disseminated education to encourage participation in BP screening and reducing salt intake. 6 South Korea has a similar trend for stroke mortality to Japan. The age-adjusted mortality from CVD decreased from Figure 4.…”

The taste of salt measured by a simple test and blood pressure in Japanese women and men

“…21,22 A simple taste test using salt-impregnated taste strips overcomes the disadvantages of the standard taste tests, such as the whole-mouth method, the micropipette method and the paper filter disk stimulation method in the following respects: the test is less time-consuming, administering it requires no special training and there is no need to prepare a testing solution, for example, salt solution. 23 This makes it possible to use the test repeatedly in clinical and community settings; the effects of dietary salt restriction can be evaluated by the subjects' taste threshold for salt both before and after health education.…”

The High-risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) study: study design and cardiovascular risk factors at the baseline survey

“…Some areas have attempted to control hypertension by cooperation between researchers, local municipalities, and residents and have achieved excellent results. 23,36 However, several have not been as successful with promotions of population strategy remaining unpopular in Japan.…”

“…These findings demonstrate that population-based strategy, involving intervention in a large number of low-risk subjects, is effective for reducing risk in the whole population. [14][15][16] The majority of trials that have attempted to improve cardiovascular risk factors by population strategy in communities [17][18][19][20][21][22][23] or in worksites 24 have been carried out in Western populations. Accordingly, in 1998 we initiated the High-risk and Population Strategy for Occupational Health Promotion study (HIPOP-OHP study 25 ) that incorporated a program for improving cardiovascular risk factors at workplaces.…”