From the Institute of Community Medicine (H.I., T.S.), University of
Tsukuba, Ibaraki-ken, Japan; the Department of Epidemiology and Mass
Examination (Y.N., S.S., A.K., M.I.), Osaka Medical Center for Cancer and
Cardiovascular Diseases, Osaka, Japan; the Department of Public Health (M.K.),
Ehime University School of Medicine, Ehime, Japan; the Division of
Epidemiology (D.R.J.), School of Public Health, University of Minnesota,
Minneapolis, Minn; and the Osaka Prefectural Institute of Public Health
(Y.K.), Osaka, Japan.
Correspondence to Hiroyasu Iso, MD, Institute of Community Medicine, University of Tsukuba, 1–1-1, Tennodai, Tsukuba-shi, Ibaraki-ken 305, Japan.
Background and Purpose—Although
randomized clinical trials have demonstrated the benefit of
antihypertensive treatment in preventing stroke, the effectiveness of
community-based programs is largely unknown. We investigated long-term
community-based prevention activities.
Methods—In rural northeastern Japan, people aged
Results—More than 80% of people aged 40 to 69 years were
screened in both communities in the 1960s. One community charged for
screening services after 1968, whereas the other community intensified
intervention; subsequently, screening rates and the follow-up of
hypertensive individuals declined in the minimal intervention
community, especially in men. In men, stroke incidence declined more
(P<0.001) in the full intervention (42% in the period
1970 to 1975, 53% in the period 1976 to 1981, and 75% in the period
1982 to 1987) than in the minimal intervention community (5% increase,
20% decrease, and 29% decrease, respectively); in women, the stroke
incidence declined about 45% to 65% in both communities. Changes in
stroke prevalence paralleled those in stroke incidence. Trends in
systolic blood pressure levels tend to explain the differential
stroke rates in men.
Conclusions—Delivery of hypertension control services through
intensive, free, community-wide screening and health education was
effective in prevention of stroke for men in a community.
© 1998 American Heart Association, Inc.
Original Contributions
Effects of a Long-term Hypertension Control Program on Stroke Incidence and Prevalence in a Rural Community in Northeastern Japan
30 years
numbered 3219 in the full intervention community and 1468 in the
minimal intervention community in 1965. Systematic blood pressure
screening and health education began in 1963. Stroke was
registered through 1987.
Key Words: community medicine • hypertension • intervention studies • stroke prevention
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