Disability days associated with detection and treatment in a hypertension control program.

Labeling individuals as hypertensive has been associated with increased absenteeism from work. Distributions of disability days were compared for the years before and after screening for hypertension among 10,049 participants in a clinical trial of intensive antihypertensive therapy. Stepped care participants attended special clinics and referred care participants returned to their usual sources of medical care. For those unaware of their hypertension at screening, disability days increased between baseline and one year among referred care (n = 1805), while there was no change among stepped care (n = 1842) participants. Neither referred care (n = 1868) nor stepped care (n = 1906) participants who were aware but untreated at baseline reported a change in disability days over the following year. For those aware and treated at baseline, there was no change in disability days in referred care (n = 1275), but a decrease was reported in stepped care (n = 1353). Further descriptive analyses suggest that neither labeling alone nor treatment alone was associated with increased absenteeism. However, detection and treatment were associated with increased absenteeism among newly diagnosed referred care hypertensives, while management of previously treated hypertensives in stepped care clinics was associated with reduced absenteeism. Because these latter comparisons are made between groups stratified on a postrandomization variable, selection bias is possible and interpretations must be made with caution.