Abstract
A study was made of the changes in the treatment of hypertension, in the effectiveness of that treatment, and in mortality from cerebrovascular stroke in men and women in two counties in Finland. One of these counties was North Karelia, where a comprehensive cardiovascular programme based in the community had been launched in 1972. Cross sectional surveys in large representative samples of the middle aged populations were carried out in 1972, 1977, and 1982. Average annual mortality from stroke adjusted for age was calculated for the two year periods 1971-2, 1977-8, and 1980-1. The proportion of hypertensive men being effectively treated for their hypertension increased in both areas from 1972 to 1977 and further from 1977 to 1982. Mortality from stroke in middle aged men decreased in both areas during both observation periods. The proportion of hypertensive women being effectively treated greatly increased in both areas from 1972 to 1977. This was associated with a large decline in mortality from stroke. In North Karelia the proportion of women being effectively treated was remarkably high but decreased somewhat between 1977 and 1982; this decrease was associated with an increase in mortality from stroke in the women aged 35-64. These results support the idea that effective antihypertensive treatment in the community is a major determinant of mortality from stroke in both men and women.
Full text
PDF




Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Abu-Zeid H. A., Choi N. W., Maini K. K., Hsu P. H., Nelson N. A. Relative role of factors associated with cerebral infarction and cerebral hemorrhage. A matched pair case-control study. Stroke. 1977 Jan-Feb;8(1):106–112. doi: 10.1161/01.str.8.1.106. [DOI] [PubMed] [Google Scholar]
- Carter A. B. Hypotensive therapy in stroke survivors. Lancet. 1970 Mar 7;1(7645):485–489. doi: 10.1016/s0140-6736(70)91577-1. [DOI] [PubMed] [Google Scholar]
- Dustan H. P., Page I. H., Tarazi R. C., Frohlich E. D. Arterial pressure responses to discontinuing antihypertensive drugs. Circulation. 1968 Mar;37(3):370–379. doi: 10.1161/01.cir.37.3.370. [DOI] [PubMed] [Google Scholar]
- Elharrar V., Foster P. R., Jirak T. L., Gaum W. E., Zipes D. P. Alterations in canine myocardial excitability during ischemia. Circ Res. 1977 Jan;40(1):98–105. doi: 10.1161/01.res.40.1.98. [DOI] [PubMed] [Google Scholar]
- Finnerty F. A., Jr Step-down therapy in hypertension. Importance in long-term management. JAMA. 1981 Dec 4;246(22):2593–2596. [PubMed] [Google Scholar]
- Hodes C., Rogers P. A., Everitt M. G. High blood pressure. detection and treatment by general practitioners. Br Med J. 1975 Jun 21;2(5972):674–677. doi: 10.1136/bmj.2.5972.674. [DOI] [PMC free article] [PubMed] [Google Scholar]
- KANNEL W. B., DAWBER T. R., COHEN M. E., MCNAMARA P. M. VASCULAR DISEASE OF THE BRAIN--EPIDEMIOLOGIC ASPECTS: THE FARMINGHAM STUDY. Am J Public Health Nations Health. 1965 Sep;55:1355–1366. doi: 10.2105/ajph.55.9.1355. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kannel W. B., Dawber T. R., Sorlie P., Wolf P. A. Components of blood pressure and risk of atherothrombotic brain infarction: the Framingham study. Stroke. 1976 Jul-Aug;7(4):327–331. doi: 10.1161/01.str.7.4.327. [DOI] [PubMed] [Google Scholar]
- Kannel W. B., Wolf P. A., Verter J., McNamara P. M. Epidemiologic assessment of the role of blood pressure in stroke. The Framingham study. JAMA. 1970 Oct 12;214(2):301–310. [PubMed] [Google Scholar]
- Nissinen A., Tuomilehto J., Elo J., Salonen J. T., Puska P. Implementation of a hypertension control program in the county of North Karelia, Finland. Public Health Rep. 1981 Nov-Dec;96(6):503–513. [PMC free article] [PubMed] [Google Scholar]
- Puska P., Salonen J. T., Nissinen A., Tuomilehto J., Vartiainen E., Korhonen H., Tanskanen A., Rönnqvist P., Koskela K., Huttunen J. Change in risk factors for coronary heart disease during 10 years of a community intervention programme (North Karelia project). Br Med J (Clin Res Ed) 1983 Dec 17;287(6408):1840–1844. doi: 10.1136/bmj.287.6408.1840. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rabkin S. W., Mathewson F. A., Tate R. B. Long term changes in blood pressure and risk of cerebrovascular disease. Stroke. 1978 Jul-Aug;9(4):319–327. doi: 10.1161/01.str.9.4.319. [DOI] [PubMed] [Google Scholar]
- Rosner B., Hennekens C. H., Kass E. H., Miall W. E. Age-specific correlation analysis of longitudinal blood pressure data. Am J Epidemiol. 1977 Oct;106(4):306–313. doi: 10.1093/oxfordjournals.aje.a112466. [DOI] [PubMed] [Google Scholar]
- Salonen J. T., Puska P., Kottke T. E., Heinonen O. P. Coronary risk factor clustering patterns in eastern Finland. Int J Epidemiol. 1981 Sep;10(3):203–210. doi: 10.1093/ije/10.3.203. [DOI] [PubMed] [Google Scholar]
- Salonen J. T., Puska P., Tuomilehto J., Homan K. Relation of blood pressure, serum lipids, and smoking to the risk of cerebral stroke. A longitudinal study in Eastern Finland. Stroke. 1982 May-Jun;13(3):327–333. doi: 10.1161/01.str.13.3.327. [DOI] [PubMed] [Google Scholar]
- Silman A. J. Hypertension in women: a separate case for treatment? Br Med J (Clin Res Ed) 1984 Oct 20;289(6451):1021–1022. doi: 10.1136/bmj.289.6451.1021. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tuomilehto J., Nissinen A., Salonen J. T., Kottke T. E., Puska P. Community programme for control of hypertension in North Karelia, Finland. Lancet. 1980 Oct 25;2(8200):900–904. doi: 10.1016/s0140-6736(80)92059-0. [DOI] [PubMed] [Google Scholar]
- Tuomilehto J., Puska P., Nissinen A. Hypertension programme of the North Karelia Project. Scand J Soc Med. 1976;4(2):67–70. [PubMed] [Google Scholar]
- Ueshima H., Iida M., Shimamoto T., Konishi M., Tsujioka K., Tanigaki M., Nakanishi N., Ozawa H., Kojima S., Komachi Y. Multivariate analysis of risk factors for stroke. Eight-year follow-up study of farming villages in Akita, Japan. Prev Med. 1980 Nov;9(6):722–740. doi: 10.1016/0091-7435(80)90017-1. [DOI] [PubMed] [Google Scholar]
- Wilber J. A., Barrow J. G. Hypertension--a community problem. Am J Med. 1972 May;52(5):653–663. doi: 10.1016/0002-9343(72)90055-1. [DOI] [PubMed] [Google Scholar]