COMMUNITY-BASED EDUCATION CLASSES FOR HYPERTENSION CONTROL - A 1.5-YEAR RANDOMIZED CONTROLLED TRIAL

Community-based hypertension control is important for primary preventi on of cardiovascular disease. In this study, untreated men and women a ged 35 to 69 years were randomly assigned to an intervention (n=56) or control(n=j5) group in a 1.5-year community-based education program. Subjects had no evidence of hypertensive end-organ defects and had scr eening blood pressures of 140 to 179 mmHg systolic and/or 90 to 109 mm Hg diastolic, with no difference in mean blood pressure between group s (148 to 150 mm Hg for mean systolic aid 83 to 84 mm Hg for mean dias tolic pressures). The intervention group took four education classes i n the first 6 months and four classes during the next year, and the co ntrol group took two classes. Health education focused on reduced diet ary sodium and increased mill; intake, brisk walking, and, if necessar y, 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 mo nths and 1.5 years (P<.05), with or without inclusion oi those subject s who began antihypertensive medication. Diastolic pressure and body m ass index did not change significantly between groups. Urinary sodium excretion declined in the intervention bur not in the control group (d ifferences between groups: P=.04 at 6 months and P=.07 at 1.5 years). According to a behavioral questionnaire, sodium reduction and milk inc rease 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 an d P<.01 at 1.5 years). Mean ethanol intake was reduced in the interven tion but not the control group (P=.01 at 1.5 years). This community-ba sed hypertension control program was effective in reducing systolic pr essure levels by nonpharmacological means during the first 6 months an d maintaining the reduction for 1.5 years.