Hypertension treatment without labelling effects: the North Karelia Project

Increases in disability and work loss have been noted following hypertension identification and treatment. To determine if iatrogenic disability is a necessary side-effect of successful treatment, self-reports of days lost from work and days spent in bed because of illness in the year before interview were compared in 1972 and 1977 for three groups in eastern Finland: hypertensives who had been told of their hypertension before 1972, hypertensives newly identified by screening in 1972, and a group of normal controls. The groups were stratified by sex and residence (urban or rural), and analysis of covariance was used to adjust for the effects of age differences among the groups. In 1972, the hypertensives identified before 1972 were significantly older and had significantly higher systolic blood pressure levels than the hypertensives identified in 1972. Hypertensives identified before 1972 had higher work loss and days spent in bed than hypertensives identified in 1972. This association was independent of age, sex, residence, and systolic blood pressure. Upon resurvey in 1977, the group with hypertension newly identified in 1972 had no greater increase in work loss or days spent in bed due to illness than the normal controls. These data support the hypothesis that hypertension identification and treatment can be but does not have to be associated with significant increases in occupational disability and days spent in bed due to illness.