Changes in blood pressure and antihypertensive treatment in a community over four years.

In 1971 persons aged 50 to 59 years in Albury were screened for hypertension and those with diastolic blood pressure equal to or over 110 mm Hg were notified. On screening of the sample in 1975, the proportion of persons receiving treatment had doubled to 22%. Most of those newly receiving treatment in 1975 had had diastolic blood pressures under 110 mm Hg in 1971. The mean systolic and diastolic pressures of the newly treated group had fallen by 13-7 and 9-1 mm Hg respectively to 153-5 and 91-6 mm Hg. The mean pressures of subjects already receiving treatment in 1971 and continuing it remained higher (163-1 mm Hg systolic and 100-9 mm Hg diastolic), despite their receiving relatively more medication. The latter group was composed of patients likely to have had more severe hypertension originally, and the importance of effective treatment for them is emphasized. The frequency with which subjects with mild hypertension are being treated demonstrates the urgent need to complete randomized controlled trials of treatment in this group.

The rate of initiation of treatment for hypertension in a community, 1971--1975.

In 1971 persons aged 50-59 in a community were screened for hypertension and those with diastolic BP greater than or equal to 110 mmHg were notified. On reviewing the sample in 1975 the treatment rate had doubled to 22%. Screening in 1971 was followed by an immediate rise in numbers starting treatment, most being notified cases. Thereafter initiation of treatment at a rate of 3-8 cases per 100 persons per year chiefly reflected identification of subjects deemed to need treatment in the ordinary course of medical practice. Of those starting treatment during the four years 25% had stopped it by 1975. The influence of screening and other factors on the rate of initiation of treatment and adherence to it are discussed. With an already high attendance rate at doctors, regular screening of this whole age group seems feasible within the framework of general practice. The high treatment rate found in 1975 underlines the urgent need for the indications currently used for starting treatment to be validated.

Blood pressure in middle-aged people in Albury and Melbourne - implications for screening.

Prevalence rates of hypertension and its treatment in two population samples of middle-aged people, one in Albury and one in Melbourne, are described. On average, Italian-born subjects had lower pressures than their Australian-born neighbours. The proportions of Australian-born people in the two centres who had been previously diagnosed were respectively 22% and 32% and the proportions with diastolic blood pressure greater than or equal to 110 mm Hg were 13% and 9%. About one half of the latter had never been told they had high blood pressure. Postal follow-up in the second post-survey year indicated that treatment rates had nearly doubled, many people with relatively low survey pressures stating they were now on therapy. Screening may precipitate over-use of antihypertensive drugs. The recent finding that 80% of middle-aged people in Albury had been to a doctor in the previous 12 months and that in a high proportion the blood pressure had been measured suggests that control of hypertension in Australia may be best achieved by developing surveillance in the context of ordinary medical practice.

Arrhythmia prophylaxis: Long-term suppressive medication.

The author describes the notions that led to initiation of controlled trials of long-term medication with antiarrhythmic drugs following myocardial infarction, and reviews reports of controlled trials with diphenylhydantoin, alprenolol, and procaine amide. It is concluded that, so far as possible widespread prophylactic use of these drugs to prevent sudden death is concerned, diphenylhydantoin has no place, while procaine amide cannot be evaluated on a large scale because of the frequency with which it causes serious adverse reactions. There is no bar to an extended trial with alprenolol or comparable beta-blocking drugs. The author believes that nonspecific prophylactic long-term use of antiarrhythmic drugs to prevent sudden coronary death outside the hospital is unlikely to prove rewarding.