Iso H, Shimamoto T, Yokota K, Sankai T, Jacobs D R, Komachi Y
Institute of Community Medicine, University of Tsukuba, Ibaraki, Japan.
Hypertension. 1996 Apr;27(4):968-74. doi: 10.1161/01.hyp.27.4.968.
Community-based hypertension control is important for primary prevention of cardiovascular disease. In this study, untreated men and women aged 35 to 69 years were randomly assigned to an intervention (n=56) or control (n=55) group in a 1.5-year community-based education program. Subjects had no evidence of hypertensive end-organ defects and had screening blood pressures of 140 to 179 mm Hg systolic and/or 90 to 109 mm Hg diastolic, with no difference in mean blood pressure between groups (148 to 150 mm Hg for mean systolic and 83 to 84 mm Hg for mean diastolic pressures). The intervention group took four education classes in the first 6 months and four classes during the next year, and the control group took two classes. Health education focused on reduced dietary sodium and increased milk intake, brisk walking, and, if necessary, reduction of alcohol and sugar intakes. Antihypertensive medication was started less often in the intervention than in the control group at 1.5 years (9% versus 24%, P <.05). Mean systolic pressure was 5 to 6 mm Hg less in the intervention than in the control group at both 6 months and 1.5 years (P <.05), with or without inclusion of those subjects who began antihypertensive medication. Diastolic pressure and body mass index did not change significantly between groups. Urinary sodium excretion declined in the intervention but not in the control group (differences between groups: P=.04 at 6 months and P=.07 at 1.5 years). According to a behavioral questionnaire, sodium reduction and milk increase were greater in the intervention than the control group (sodium: P <.01 at 6 months and P=.08 at 1.5 years; milk: P <.001 at 6 months and P <.01 at 1.5 years). Mean ethanol intake was reduced in the intervention but not the control group (P=.04 at 1.5 years). This community-based hypertension control program was effective in reducing systolic pressure levels by nonpharmacological means during the first 6 months and maintaining the reduction for 1.5 years.
基于社区的高血压控制对于心血管疾病的一级预防至关重要。在本研究中，年龄在35至69岁之间未经治疗的男性和女性被随机分配到一个为期1.5年的基于社区的教育项目中的干预组（n = 56）或对照组（n = 55）。受试者没有高血压终末器官损害的证据，筛查血压收缩压为140至179毫米汞柱和/或舒张压为90至109毫米汞柱，两组之间平均血压无差异（平均收缩压为148至150毫米汞柱，平均舒张压为83至84毫米汞柱）。干预组在前6个月参加了4次教育课程，在接下来的一年中参加了4次课程，对照组参加了2次课程。健康教育的重点是减少饮食中的钠摄入、增加牛奶摄入量、快走，必要时减少酒精和糖的摄入量。在1.5年时，干预组开始使用抗高血压药物的频率低于对照组（9%对24%，P<.05）。在6个月和1.5年时，干预组的平均收缩压比对照组低5至6毫米汞柱（P<.05），无论是否纳入开始使用抗高血压药物的受试者。两组之间舒张压和体重指数没有显著变化。干预组的尿钠排泄量下降，而对照组没有（组间差异：6个月时P =.04，1.5年时P =.07）。根据一份行为问卷，干预组的钠减少和牛奶增加情况比对照组更明显（钠：6个月时P<.01，1.5年时P =.08；牛奶：6个月时P<.001，1.5年时P<.01）。干预组的平均乙醇摄入量减少，而对照组没有（1.5年时P =.04）。这个基于社区的高血压控制项目在最初6个月通过非药物手段有效降低了收缩压水平，并在1.5年内维持了这种降低效果。
