Iso H, Shimamoto T, Sankai T, Yokota K, Harada M, Wakabayashi Y, Ohtani K, Inagawa M, Ohki M, Miyagaki T
Institute of Community Medicine, University of Tsukuba.
Nihon Koshu Eisei Zasshi. 1993 Mar;40(3):147-58.
To evaluate the effectiveness of lifestyle modification community-based programs on blood pressure reduction, blood pressure changes were examined according to frequency of attendance at these adult classes. The subjects were 1,017 men and women aged 40-69 who participated in a survey from 1985 to 1987, whose blood pressure was > = 140 mmHg for systolic, and/or > = 90 mmHg for diastolic and/or with antihypertensive medication use in the earlier 1981-1984 surveys. Adult classes were conducted eleven times between 1982 and 1987, emphasizing primarily reduction of salt intake, weight control if necessary, and alcohol modification. Blood pressure changes between 1981-1984 and 1985-1988 were examined in relation to the number of classes attended, stratified by antihypertensive medication use. In the group with no medication use in both surveys (n = 347), there was a significantly larger decline in systolic and diastolic blood pressures with an increase in the number of classes attended (p < 0.001). A similar trend was observed in other groups: a starting medication group (n = 198), a quitting medication group (n = 100) and a continuous medication group (n = 372). The blood pressure trend in the no medication group remained significant after controlling for age, initial blood pressure, follow-up years and the number of follow-up screenings attended. For the no medication group, there was no significant association between the number of classes attended and changes in relative weight index and alcohol intake. The proportion of persons reporting dietary modification of reduction in salt was larger, and mean 24-hour urine sodium excretion was smaller, with increasing number of classes attended in the 1985-1988 surveys. Furthermore, the proportion of persons who were able to reduce salt intake between the two survey periods was higher with an increase in the number of classes attended. Mean urine sodium excretion was smaller in those who reported reduction of salt intake than those who did not. Although this study is not a randomized controlled trial, these results suggest that a community-based education program of adult classes can be effective in reduction of blood pressure levels through modification of diet.
为评估基于社区的生活方式改善项目在降低血压方面的效果，根据参加这些成人课程的频率，对血压变化进行了检查。研究对象为1017名年龄在40至69岁之间的男性和女性，他们在1985年至1987年期间参与了一项调查，其收缩压≥140 mmHg，和/或舒张压≥90 mmHg，和/或在1981年至1984年早期调查中使用过抗高血压药物。1982年至1987年间举办了11次成人课程，主要强调减少盐摄入量、必要时控制体重以及调整饮酒习惯。根据参加课程的次数，对1981 - 1984年和1985 - 1988年期间的血压变化进行了检查，并按抗高血压药物使用情况进行分层。在两次调查中均未使用药物的组（n = 347）中，随着参加课程次数的增加，收缩压和舒张压的下降幅度明显更大（p < 0.001）。在其他组中也观察到了类似趋势：开始用药组（n = 198）、停药组（n = 100）和持续用药组（n = 372）。在控制了年龄、初始血压、随访年限和参加随访筛查次数后，未用药组的血压趋势仍然显著。对于未用药组，参加课程的次数与相对体重指数和酒精摄入量的变化之间没有显著关联。在1985 - 1988年的调查中，报告减少盐摄入量的饮食调整的人数比例更大，平均24小时尿钠排泄量更小，且随着参加课程次数的增加而增加。此外，在两个调查期间能够减少盐摄入量的人数比例随着参加课程次数的增加而更高。报告减少盐摄入量的人的平均尿钠排泄量比未减少盐摄入量的人更小。尽管这项研究不是随机对照试验，但这些结果表明，基于社区的成人课程教育项目通过调整饮食可以有效降低血压水平。
