[Effectiveness of a community-based education program on blood pressure reduction for cardiovascular disease...

To evaluate the effectiveness of lifestyle modification community-based programs on blood pressure reduction, blood pressure changes were examined according to frequency of attendance at these adult classes. The subjects were 1,017 men and women aged 40-69 who participated in a survey from 1985 to 1987, whose blood pressure was > = 140 mmHg for systolic, and/or > = 90 mmHg for diastolic and/or with antihypertensive medication use in the earlier 1981-1984 surveys. Adult classes were conducted eleven times between 1982 and 1987, emphasizing primarily reduction of salt intake, weight control if necessary, and alcohol modification. Blood pressure changes between 1981-1984 and 1985-1988 were examined in relation to the number of classes attended, stratified by antihypertensive medication use. In the group with no medication use in both surveys (n = 347), there was a significantly larger decline in systolic and diastolic blood pressures with an increase in the number of classes attended (p < 0.001). A similar trend was observed in other groups: a starting medication group (n = 198), a quitting medication group (n = 100) and a continuous medication group (n = 372). The blood pressure trend in the no medication group remained significant after controlling for age, initial blood pressure, follow-up years and the number of follow-up screenings attended. For the no medication group, there was no significant association between the number of classes attended and changes in relative weight index and alcohol intake. The proportion of persons reporting dietary modification of reduction in salt was larger, and mean 24-hour urine sodium excretion was smaller, with increasing number of classes attended in the 1985-1988 surveys. Furthermore, the proportion of persons who were able to reduce salt intake between the two survey periods was higher with an increase in the number of classes attended. Mean urine sodium excretion was smaller in those who reported reduction of salt intake than those who did not. Although this study is not a randomized controlled trial, these results suggest that a community-based education program of adult classes can be effective in reduction of blood pressure levels through modification of diet.