Decrease of blood pressure by community-based strategies

La ciudad de Rauch presentaba en 1997 alta prevalencia de hipertensión arterial (HA) y bajos niveles de tratamiento y control. Para evaluar el impacto de actividades de intervención comunitarias sobre la presión arterial (PA) reencuestamos en el año 2003 a una cohorte de 1526 habitantes de 15-75 años. Las actividades de intervención fueron el estudio inicial, la indicación de concurrir a su médico cuando se hallaban alteraciones, la provisión gratuita de antihipertensivos y la difusión por medios masivos de los resultados del estudio y de hábitos saludables de vida. La PA fue medida en el domicilio por enfermeras especialmente entrenadas, considerando PA sistólica y diastólica (PAS y PAD) a los promedios de tres registros en una ocasión. Se reencuestaron 1307 individuos (85.65%). La PAS descendió de 137.98 ± 0.57 a 132.49 ± 0.53 mm Hg (p<0.01) y la PAD de 88.73 ± 0.38 a 81.87 ± 0.33 mm Hg (p<0.01). La PA disminuyó en ambos sexos, en todos los grupos etáreos y en el subgrupo sin antihipertensivos. El porcentaje de sujetos con antihipertensivos aumentó de 12.2 a 20.4 (p<0.01) y se observó una relación significativa entre los percentilos de los cambios de la PA y los cambios del peso en sujetos con y sin antihipertensivos. Las estrategias de intervención comunitaria fueron efectivas para controlar la PA y, probablemente, para disminuir el riesgo cardiovascular en una comunidad con alta prevalencia de HA.

In a cross section study performed in Rauch in 1997 we found a high prevalence of hypertension and low levels of treatment and control. To evaluate the impact of the community-based intervention activities on blood pressure (BP), we made a cohort study in 1526 inhabitants aged between 15 and 75 years in 2003. The initial study, the advice to consult the family doctor when alterations were found, the free provision of antihypertensive drugs, the press diffusion of the study results and a healthy lifestyle were included among the intervention activities. BP was measured in the subjects' residence by especially trained nurses, considering systolic BP (SBP) and diastolic BP (DBP) as the average of three measurements in one occasion. A total of 1307 subjects (85.65%) were re-interviewed. SBP decreased from 137.98 +/- 0.57 to 132.49 +/- 0.53 mm Hg (p < 0.01) and DBP from 88.73 +/- 0.38 to 81.87 +/- 0.33 mm Hg (p < 0.01). Pressure decrease was observed in all the age groups, in both sexes and in the subgroup without receiving antihypertensive drugs. The percentage with antihypertensive drugs increased from 12.2 to 20.4 (p < 0.01). A significant relationship was observed between the percentiles of the BP changes and weight changes in subjects with and without antihypertensive drugs. Community-based intervention strategies were effective to BP control and, probably, to decrease the cardiovascular risk in a community with high prevalence of hypertension.

Decrease of blood pressure by community-based strategies

La ciudad de Rauch presentaba en 1997 alta prevalencia de hipertensión arterial (HA) y bajos niveles de tratamiento y control. Para evaluar el impacto de actividades de intervención comunitarias sobre la presión arterial (PA) reencuestamos en el año 2003 a una cohorte de 1526 habitantes de 15-75 años. Las actividades de intervención fueron el estudio inicial, la indicación de concurrir a su médico cuando se hallaban alteraciones, la provisión gratuita de antihipertensivos y la difusión por medios masivos de los resultados del estudio y de hábitos saludables de vida. La PA fue medida en el domicilio por enfermeras especialmente entrenadas, considerando PA sistólica y diastólica (PAS y PAD) a los promedios de tres registros en una ocasión. Se reencuestaron 1307 individuos (85.65%). La PAS descendió de 137.98 ± 0.57 a 132.49 ± 0.53 mm Hg (p<0.01) y la PAD de 88.73 ± 0.38 a 81.87 ± 0.33 mm Hg (p<0.01). La PA disminuyó en ambos sexos, en todos los grupos etáreos y en el subgrupo sin antihipertensivos. El porcentaje de sujetos con antihipertensivos aumentó de 12.2 a 20.4 (p<0.01) y se observó una relación significativa entre los percentilos de los cambios de la PA y los cambios del peso en sujetos con y sin antihipertensivos. Las estrategias de intervención comunitaria fueron efectivas para controlar la PA y, probablemente, para disminuir el riesgo cardiovascular en una comunidad con alta prevalencia de HA.(AU)

In a cross section study performed in Rauch in 1997 we found a high prevalence of hypertension and low levels of treatment and control. To evaluate the impact of the community-based intervention activities on blood pressure (BP), we made a cohort study in 1526 inhabitants aged between 15 and 75 years in 2003. The initial study, the advice to consult the family doctor when alterations were found, the free provision of antihypertensive drugs, the press diffusion of the study results and a healthy lifestyle were included among the intervention activities. BP was measured in the subjects residence by especially trained nurses, considering systolic BP (SBP) and diastolic BP (DBP) as the average of three measurements in one occasion. A total of 1307 subjects (85.65%) were re-interviewed. SBP decreased from 137.98 +/- 0.57 to 132.49 +/- 0.53 mm Hg (p < 0.01) and DBP from 88.73 +/- 0.38 to 81.87 +/- 0.33 mm Hg (p < 0.01). Pressure decrease was observed in all the age groups, in both sexes and in the subgroup without receiving antihypertensive drugs. The percentage with antihypertensive drugs increased from 12.2 to 20.4 (p < 0.01). A significant relationship was observed between the percentiles of the BP changes and weight changes in subjects with and without antihypertensive drugs. Community-based intervention strategies were effective to BP control and, probably, to decrease the cardiovascular risk in a community with high prevalence of hypertension.(AU)

[Associated variables to hypertension in a region of Argentina]. / Variables asociadas a hipertensión arterial en una región de la Argentina.

We conducted a study in a random sample of 1523 inhabitants (15-75 years old) of Rauch city to determine risk factors prevalence to development hypertension and cardiovascular diseases. We measured blood pressure, weight, height, waist circumference, cholesterol and glucose levels, sodium excretion, and alcohol and tobacco consumption. We found a high prevalence of hypertension (43.20% in men and 28.50% in women), and obesity-overweight (54.81% in men and 44.65% in women), both of them augmented with aging. Only 4% of hypertensive subjects were being controlled and only 32% of them were aware of their condition. Men showed a marked increment of prevalence of hypertension and obesity-overweight between groups of 15-24 years and 25-34 years. Women had delayed and more gradual increments. In male and female respectively, the prevalence of hypercholesterolemia was 26.86 and 13.81, the prevalence of diabetes was 3.42 and 1.53, and the prevalence of tobacco consumption was 34.61 and 20.83. Higher BMI and waist circumference identified subjects with higher blood pressure up to 54 and 65 years, in men and women, respectively. Age and waist circumference in the whole group, and alcohol consumption in men, were independently correlated with blood pressure; sodium excretion had no correlation. High prevalence of hypertension and obesity-overweight and their association suggest that the most important primary prevention measure in this community should be to prevent obesity. Low levels of awareness indicate the need of ongoing detection programs, and low grade to control of hypertension could be modified with education programs for health providers.

Variables asociadas a hipertensión arterial en una región de la Argentina. / [Associated variables to hypertension in a region of Argentina]

We conducted a study in a random sample of 1523 inhabitants (15-75 years old) of Rauch city to determine risk factors prevalence to development hypertension and cardiovascular diseases. We measured blood pressure, weight, height, waist circumference, cholesterol and glucose levels, sodium excretion, and alcohol and tobacco consumption. We found a high prevalence of hypertension (43.20

in men and 28.50

in women), and obesity-overweight (54.81

in men and 44.65

in women), both of them augmented with aging. Only 4

of hypertensive subjects were being controlled and only 32

of them were aware of their condition. Men showed a marked increment of prevalence of hypertension and obesity-overweight between groups of 15-24 years and 25-34 years. Women had delayed and more gradual increments. In male and female respectively, the prevalence of hypercholesterolemia was 26.86 and 13.81, the prevalence of diabetes was 3.42 and 1.53, and the prevalence of tobacco consumption was 34.61 and 20.83. Higher BMI and waist circumference identified subjects with higher blood pressure up to 54 and 65 years, in men and women, respectively. Age and waist circumference in the whole group, and alcohol consumption in men, were independently correlated with blood pressure; sodium excretion had no correlation. High prevalence of hypertension and obesity-overweight and their association suggest that the most important primary prevention measure in this community should be to prevent obesity. Low levels of awareness indicate the need of ongoing detection programs, and low grade to control of hypertension could be modified with education programs for health providers.

Ten-year blood pressure trends in nonhypertensive inhabitants of La Plata, Argentina.

OBJECTIVES: To compare, according to blood pressure (BP) categories, 10-year trends in BP measurements in nonhypertensive subjects and the relative risk of developing hypertension. DESIGN: Population study. BP was recorded as the average of two measures taken on a single occasion with a mercury sphygmomanometer and the auscultation method. SETTING: Residents of La Plata, aged 15 to 64 years. PARTICIPANTS: The study was based on randomly chosen individuals who, during a previous survey in 1985, were 15 to 64 years old and whose BP was below 140/90 mmHg. They were grouped according to sex and BP categories. Random age- and sex-stratified sampling of 151 men and 193 women was performed. Categories were high normal BP, optimal BP (as defined by the fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure) and normal but not optimal BP defined as BP 120 to 129/80 to 84 mmHg. RESULTS: BP increased in all categories; this increase was significant (P < 0.01) except for diastolic BP in women with high normal BP. BP increases were higher in optimal BP subjects and lower in high normal BP subjects (P < 0.01 for women and not significant for men). The relative risk of developing hypertension in high normal BP subjects was triple that in optimal BP subjects (P < 0.01). CONCLUSIONS: Increases in BP observed in optimal BP subjects stress the importance of monitoring BP changes and recommending primary prevention in the whole population.