Impact of a Rural High Blood Pressure Control Program on Hypertension Control and Cardiovascular Disease Mortality

Abstract

Kentucky is a predominantly rural state with relatively high death rates from hypertension and cardiovascular disease. We report the results of a community-based high blood pressure control educational program undertaken in two rural counties of southeastern Kentucky. In the intervention counties, systolic and diastolic blood pressures of both men and women decreased despite the five-year increase in age; moreover, hypertension was better controlled after the program, and substantial decreases in deaths due to cardiovascular disease were seen. These differences were greater among men in the two regions than among women. The results of this program suggest that, in sparsely populated rural areas, existing resources and programs can be successfully utilized in a communitywide cardiovascular disease risk reduction educational program.

A systematic review of the effectiveness of primary health education or intervention programs in improving rural womenʼs knowledge of heart disease risk factors and changing lifestyle behaviours.

“…Three trials compared the effects of interventions on physical activity, 20-22 one on smoking 23 and five on multiple risk factors. [24][25][26][27][28] One trial was conducted in Belgium 20 and the remainder in the USA. [21][22][23][24][25][26][27][28] With one exception 26 all trials reported on women only.…”

“…Participants were recruited from the workplace, 24 a women's organisation, 20 through articles or advertisements in local newspapers, flyers and announcements at meetings, 22,25,26 community clinics and private practices 21,27 and through community networks such as churches and businesses in the area. 26 With one exception 26 all the remaining studies were of women only.…”

“…Interventions reported consisted of group work, 20,21,23,25,26 educational materials, 20,22-24,26-28 counselling, 24 motivational interviewing 21 and telephone support. 20,23,27 Group work sessions ranged from one 90-min meeting 20 to 24 h over 12 weeks.…”

“…20,27 Educational materials included written materials, 20,22 videos 22,27 and computer-tailored magazines. 24 One study 26 used various educational programs targeting different members of the community. The interventions were conducted by an educator, 25 health professional, 27 researchers 20,22,28 and an advanced practice nurse.…”

Evaluation of hypertension screening in the hutterite population

“…For example, Sutterer, Carey, Silver, and Nash (1989) found that, while community screening did increase knowledge of hypertension, it did not necessarily lead to risk modification. On the other hand, Kotchen et al (1986) demonstrated that the prevalence of hypertension in a rural community could be reduced through a hypertension screening program. As discovered in worksite screening programs, the success of community screening is largely dependent on whether the participants seek appropriate follow-up care.…”