Impact of the high-risk and mass strategies on hypertension control and stroke mortality in primary health care.

Stroke has been the second leading cause of death in Taiwan in recent years. Following a 6-month pilot study in Yu-Chi in 1993, a 3.5-year hypertension control programme was performed to examine the effectiveness of combined high-risk and mass strategies in a rural community with limited medical resources. All Yu-Chi residents aged 40 years and older were invited to participate in the programme. The high-risk strategies included hypertension screening, home visits, and follow-up for the hypertensives. The mass strategies included health education and village-based campaigns. Changes over time in the participants' hypertension knowledge, behaviour, and blood pressure control status were evaluated. A comparison of the stroke mortality between the intervention community and a neighbourhood reference community before and after the intervention programme was performed. A total of 4977 residents were screened and 3761 completed the first and second rescreening. The hypertension knowledge and behaviour scores in the hypertensives significantly improved, systolic and diastolic blood pressure and waist-to-hip ratio significantly reduced, and the rates of hypertension treatment and control increased significantly at 1 and 3.5 years after intervention. In contrast, blood pressure levels increased significantly in the normotensives. Between 1994 and 1997, stroke mortality rate decreased by 39.9 and 4.8% in the intervention and reference communities, respectively. The results indicated that the community-based hypertension control programme was effective. The immediate decline in stroke mortality appeared to be mostly related to the high-risk strategies.