IMPROVING HYPERTENSION CONTROL AMONG EXCESSIVE ALCOHOL DRINKERS - A RANDOMIZED CONTROLLED TRIAL IN FRANCE

Objectives - To improve blood pressure control among hypertensive (>14 0/90 mmHg) excessive alcohol drinkers. Design - Fourteen worksite phys icians were randomised into an intervention group and a control group. The intervention was based on training worksite physicians and follow up of those hypertensive subjects defined as excessive drinkers. Foll ow up was based on self monitoring of alcohol consumption by the subje ct, in view of the results of their gamma glutamyl transferase (GGT) a ctivity determination. Setting - Fourteen workplaces in France mainly in the industrial sector. Subjects - Altogether 15 301 subjects were s creened by the 14 physicians: 129 of these were included in the study. Main outcome measures - This was the difference between the initial s ystolic blood pressure (SBP) and the SBP one year later (Delta BP). Se condary criteria were the difference between the initial and final dia stolic blood pressure (Delta DBP) and Delta BP at two years; antihyper tensive treatment; stated alcohol consumption (Delta AC); Delta GGT; a nd body mass index (Delta BMI). Results - The decrease in SEP levels w as significantly larger in the intervention group than in the control group: at one year, Delta SBP values were -11.9 (15.6) mmHg and -4.6 ( 13.8) respectively (p<0.05). This benefit was still observed after two years of follow up (-13.8 (17.4) mmHg v -7.5 (14.2) mmHg (p<0.05)). N o difference was observed in DBP. The percentage of treated subjects d id not differ between groups. At one year, Delta AC was larger in the intervention group (-2.8 (5.2) U/d) than in the control group (-1.6 (3 .4) (p<0.1)). Delta GGT and Delta BMI did not differ between the two g roups. A weak positive correlation was observed between Delta AC and D elta SBP (r = 0.16). Conclusions - An intervention aimed at the hypert ensive excessive drinkers in a working population was found to be effe ctive in reducing SEP on a long term basis (two years). The mechanisms of reduction in alcohol consumption and improved drug compliance cann ot be ascertained in this pragmatic study. From a public health point of view, reducing the excess cardiovascular risk among a ''hard to rea ch'' population seems feasible with a strategy specifically designed f or this high risk group.