EFFECTS OF A LONG-TERM HYPERTENSION CONTROL PROGRAM ON STROKE INCIDENCE AND PREVALENCE IN A RURAL-COMMUNITY IN NORTHEASTERN JAPAN

Background and Purpose-Although randomized clinical trials have demons trated 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 greater than or equal to 30 y ears numbered 3219 in the full intervention community and 1468 in the minimal intervention community in 1965. Systematic blood pressure scre ening and health education began in 1963. Stroke was registered throug h 1987. Results-More than 80% of people aged 40 to 69 years were scree ned in both communities in the 1960s. One community charged for screen ing services after 1968, whereas the other community intensified inter vention; subsequently, screening rates and the follow-up of hypertensi ve individuals declined in the minimal intervention community, especia lly in men. In men, stroke incidence declined more (P<0.001) in the fu ll intervention (42% in the period 1970 to 1975, 53% in the period 197 6 to 1981, and 75% in the period 1982 to 1987) than in the minimal int ervention community (5% increase, 20% decrease, and 29% decrease, resp ectively); in women, the stroke incidence declined about 45% to 65% in both communities. Changes in stroke prevalence paralleled those in st roke incidence. Trends in systolic blood pressure levels tend to expla in the differential stroke rates in men. Conclusions-Delivery of hyper tension control services through intensive, free, community-wide scree ning and health education was effective in prevention of stroke for me n in a community.