The method used in taking BPs both in the screening and the treatment phase was a single BP measurement by a mercury manometer with the patient in the sitting position after a 3-5-minute rest. The readings were accurate to 2 mm Hg and the fifth-phase level was recorded as the diastolic BP.10 The drug treatment of all patients was begun with chlorthalidone. If this drug failed to lower the BP to the desired level (under 50 years: BP < 160 mm Hg systolic and < 95 mm Hg diastolic; over 50 years: BP < 170 mm Hg systolic and < 105 mm Hg diastolic), methyldopa was added to the treatment. In patients in whom serious side effects were caused by methyldopa, this drug was replaced by alprenolol. The results presented below are based on observations made during the years 1974 and 1975.In the statistical processing of the data, the t test was used to test the significance of the mean values obtained for the systolic and diastolic pressures; elsewhere, comparisons between two frequencies were used. Results Twenty-four of 572 men (4%) and 55 of 673 women (8%) who participated in the hypertension screening survey were under treatment for hypertension at the time of the investigation. Applying the abovementioned criteria for high BP, 223 men (39%) and 252 women (37%) had untreated high BP. Of these subjects, 200 men (90%) and 226 women (90%) participated in the second BP measurement and 115 women (51%) and 87 men (44%) still had high BP and were randomly assigned to treatment groups. After the division into the two treatment groups, the appointment with the physician was kept by 93 of 100 subjects treated under the improved system. Of those who failed to come, two had sought treatment from a private practitioner, one was dead, and four had moved away from the locality. Of the 102 subjects treated under the ordinary system, 100 subjects accepted the invitation while the other two refused to keep the appointment. (After randomization, we noted that a husband and wife had been put in different groups. Due to the nature of the study we felt it necessary to place married couples in the same group. The two of them were then placed (by lot) in the group treated under the ordinary system, causing a difference in the sizes of the two groups). Drug therapy was begun for 78 patients (84%) under the improved system and for 86 (86%) of those under the ordinary system. Drug treatment was not considered necessary for the other patients, because, upon reexamination, their BP readings no longer met the criteria for high BP. This may be ascribed either to a regression to the mean or to adaptation to the measurement situation.The factors likely to influence compliance with therapeutic regimens were evenly distributed among patients in the two groups on drug therapy and fell into a pattern similar to that of the original randomized groups (table 1). None of the differences between the groups on drug therapy were statistically significant. The mean age of those receiving drugs was 51.7 years for the improved treatment group and 51.4 years for the ordinary group. In the former group the mean for systolic pressure was 179.5 mm Hg and for diastolic pressure was 101.4 mm Hg. In the latter group the corresponding figures were 178.3 and 100.9 mm Hg (these mean values were obtained on the basis of each subject's mean, calculated from two separate screening-phase readings). Neither the mean ages nor the mean pressures differed significantly.During the year, three persons out of 78 (4%) dropped out of treatment under the improved system while under the ordinary system 16 of 86 (19%) dropped out. The difference was statistically significant (p < 0.01). By the end of the year the desired BP level had been attained by 63 (81%) of the patients under the improved system and 55 (64%) of those under the ordinary system (p < 0.05). A pressure reduction of at least 10%"1 had taken place in a total of 73 (94%) of the former and 67 (78%) of the latter group (p < 0.01). The degree of reduction was satisfactory both in patients under 50 years of age and those over this age, and was of the same order of magnitude under both the treatment systems (table 2). Of those patients under the reorganized system who had reached the desired BP level, chlorthalidone (25-50 TABLE 1. Factors Likely to Influence Compliance with Antihypertensive Treatment Improved system Ordinary system Subjects Subjects on Subjects Subjects on Factors influencing randomly divided drug therapy randomly divided drug therapy compliance (n = 100) (n = 78) (n = 102) (n = 86) Women 57 (57%) 47 (60%) 58 (57%) 51 (59%) Under 50 years of 'ge 54 (54%) 41 (53%) 57 (56%) 47 (55%) Knowledge of elevated blood pressure before screening 26 (26%) 21 (27%l) 27 (26%) 24 (28%) Under treatment at sometime previously 10 (10%) 7 (9%) 12 (12%) 11 (13%) *Systolic pressure elevated 35 (35%) 27 (35%) 32 (31%7) 29 (34%) *Diastolic pressure elevated 19 (19%C) 14 (18%) 20 (20%) 15 (17%)*Both systolic and diastolic pressures elevated 46 (46%) 37 (47%) 50 (49%) 42 (49%) *Based on the mean of readings taken at two separate screening measurements. 541
The method used in taking BPs both in the screening and the treatment phase was a single BP measurement by a mercury manometer with the patient in the sitting position after a 3-5-minute rest. The readings were accurate to 2 mm Hg and the fifth-phase level was recorded as the diastolic BP.10 The drug treatment of all patients was begun with chlorthalidone. If this drug failed to lower the BP to the desired level (under 50 years: BP < 160 mm Hg systolic and < 95 mm Hg diastolic; over 50 years: BP < 170 mm Hg systolic and < 105 mm Hg diastolic), methyldopa was added to the treatment. In patients in whom serious side effects were caused by methyldopa, this drug was replaced by alprenolol. The results presented below are based on observations made during the years 1974 and 1975.In the statistical processing of the data, the t test was used to test the significance of the mean values obtained for the systolic and diastolic pressures; elsewhere, comparisons between two frequencies were used. Results Twenty-four of 572 men (4%) and 55 of 673 women (8%) who participated in the hypertension screening survey were under treatment for hypertension at the time of the investigation. Applying the abovementioned criteria for high BP, 223 men (39%) and 252 women (37%) had untreated high BP. Of these subjects, 200 men (90%) and 226 women (90%) participated in the second BP measurement and 115 women (51%) and 87 men (44%) still had high BP and were randomly assigned to treatment groups. After the division into the two treatment groups, the appointment with the physician was kept by 93 of 100 subjects treated under the improved system. Of those who failed to come, two had sought treatment from a private practitioner, one was dead, and four had moved away from the locality. Of the 102 subjects treated under the ordinary system, 100 subjects accepted the invitation while the other two refused to keep the appointment. (After randomization, we noted that a husband and wife had been put in different groups. Due to the nature of the study we felt it necessary to place married couples in the same group. The two of them were then placed (by lot) in the group treated under the ordinary system, causing a difference in the sizes of the two groups). Drug therapy was begun for 78 patients (84%) under the improved system and for 86 (86%) of those under the ordinary system. Drug treatment was not considered necessary for the other patients, because, upon reexamination, their BP readings no longer met the criteria for high BP. This may be ascribed either to a regression to the mean or to adaptation to the measurement situation.The factors likely to influence compliance with therapeutic regimens were evenly distributed among patients in the two groups on drug therapy and fell into a pattern similar to that of the original randomized groups (table 1). None of the differences between the groups on drug therapy were statistically significant. The mean age of those receiving drugs was 51.7 years for the improved treatment group and 51.4 years for the ordinary group. In the former group the mean for systolic pressure was 179.5 mm Hg and for diastolic pressure was 101.4 mm Hg. In the latter group the corresponding figures were 178.3 and 100.9 mm Hg (these mean values were obtained on the basis of each subject's mean, calculated from two separate screening-phase readings). Neither the mean ages nor the mean pressures differed significantly.During the year, three persons out of 78 (4%) dropped out of treatment under the improved system while under the ordinary system 16 of 86 (19%) dropped out. The difference was statistically significant (p < 0.01). By the end of the year the desired BP level had been attained by 63 (81%) of the patients under the improved system and 55 (64%) of those under the ordinary system (p < 0.05). A pressure reduction of at least 10%"1 had taken place in a total of 73 (94%) of the former and 67 (78%) of the latter group (p < 0.01). The degree of reduction was satisfactory both in patients under 50 years of age and those over this age, and was of the same order of magnitude under both the treatment systems (table 2). Of those patients under the reorganized system who had reached the desired BP level, chlorthalidone (25-50 TABLE 1. Factors Likely to Influence Compliance with Antihypertensive Treatment Improved system Ordinary system Subjects Subjects on Subjects Subjects on Factors influencing randomly divided drug therapy randomly divided drug therapy compliance (n = 100) (n = 78) (n = 102) (n = 86) Women 57 (57%) 47 (60%) 58 (57%) 51 (59%) Under 50 years of 'ge 54 (54%) 41 (53%) 57 (56%) 47 (55%) Knowledge of elevated pressure before screening 26 (26%) 21 (27%l) 27 (26%) 24 (28%) Under treatment at sometime previously 10 (10%) 7 (9%) 12 (12%) 11 (13%) *Systolic pressure elevated 35 (35%) 27 (35%) 32 (31%7) 29 (34%) *Diastolic pressure elevated 19 (19%C) 14 (18%) 20 (20%) 15 (17%)*Both systolic and diastolic pressures elevated 46 (46%) 37 (47%) 50 (49%) 42 (49%) *Based on the mean of readings taken at two screening measurements. 541
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