Reduction of cardiovascular disease events by worksite hypertension treatment.

Abstract

SUMMARY A retrospective cohort study of hypertensive employees to evaluate the impact of worksite antihypertensive treatment (WST) on cardiovascular disease (CVD) over S'/i years is reported. In a union-sponsored screening from August 1973 to February 1974 hypertensives (S= 160 and/or 95 mm Hg, or on medication) were identified. Of these, standardized criteria were met by 344, of whom 150 chose WST and 194 referred care (RC). The study groups were similar in age and sex composition. Union hospitalization and death records through 1982 revealed that CVD rates were fewer in WST than RC (3.0 vs 5.4/100 person-years; p < 0.01). By contrast, nonCVD rates were similar (8.1 vs 9.6). All-cause mortality rate in WST (0.89) was significantly (p < 0.05) lower than that in RC (1.81), as was the standard mortality ratio (55.1), based on U.S. mortality in 1978. CVD mortality was also lower (0.48 vs 1.10; NS). Persons with an initial blood pressure (BP) < 160/95 mm Hg had CVD event rates that were low and similar in WST and RC (3.6 vs 3.5). However, among those with elevated BP at entry, WST subjects fared significantly better than RC (2.8 vs 6.1; p < 0.001). Furthermore, in WST, previously treated patients with elevated BP at screening experienced one-third the CVD morbidity of their counterparts in RC (3.1 vs 10.8; p < 0.01). These results extend previous evidence that WST is an effective method to achieve BP control and demonstrate that this approach to the management of hypertension alters health outcomes favorably and significantly. had demonstrated that blood pressure (BP) control reduced the incidence of cardiovascular disease (CVD). '~3 At the same time, it was apparent that, despite availability of effective antihypertensive therapy, large numbers of identified and treated hypertensives were not achieving BP control. 4 " 7 In an attempt to overcome this deficiency, several modifications of conventional approaches to the management of hypertension evolved. Among these, programs to provide worksite-based antihypertension treatment attained widespread acceptance. Early studies demonstrated that systematic, protocol-directed care provided at the worksite, primarily under the aegis of a nurse, was safe, acceptable, and achieved a high degree of BP control.8 -9 Subsequent studies demonstrated that such systematic approaches to care were actually more effective than those conventionally available in the community.10 " The assumption that better BP control would be matched by greater reduction in CVD events has encouraged expansion of these and similar programs. However, recent findings indicate that greater BP control is not invariably associated with better health outcomes.12 Therefore, it is of more than academic interest to evaluate the effectiveness of worksite antihypertensive therapy in terms of its impact on CVD morbidity and mortality.To this end, we have applied the method of a retrospective cohort study to compare, over an 8'/2-year period, the morbidity and mortality of hypertensive storeworkers who joined a ...

Job absenteeism and arterial hypertension: Results of a hypertension control program

“…Several studies have demonstratet that when a work health service has adequate equipment and facilities -either of its own or through its connection with other health services outside the company (16) -controlling hypertension in the workplace considerably reduces the indirect costs (TWI, permanent disability and mortality) caused by this disorder, and benefits not only the company and its workers but also public health in general (1,2,8,9,11). It also has, however, certain advantages over other environments, that is, the accessibility of employees, their familiarity with the health service, cost reduction, and more (15).…”

“…their place of work, not only for reasons of effectiveness (in determining influencing factors and/ or results) but also from the point of view of the efficiency (cost reduction) of the programs (1,2,6,8,9,11). their place of work, not only for reasons of effectiveness (in determining influencing factors and/ or results) but also from the point of view of the efficiency (cost reduction) of the programs (1,2,6,8,9,11).…”

Atrial natriuretic factor in normal subjects and heart failure patients. Plasma levels and renal, hormonal, and hemodynamic responses to peptide infusion.

“…The range of endogenous plasma irANF concentration was determined in peripheral venous blood from 70 normal volunteers derived from a previously characterized defined population (24), who were studied in the seated position while on a regular diet; and 31 patients with congestive heart failure on standard digoxin and diuretic therapy. In seven supine normal subjects undergoing hemodynamic study (protocol II), simultaneous blood samples were obtained from a peripheral vein and from the right ventricle.…”

Resources for Blood Pressure Screening Programs in Low Resource Settings: A Guide From the World Hypertension League

“…In a randomized controlled trial, Kaczorowski and colleagues demonstrated that a community‐based BP screening program that included cardiovascular risk assessment and education sessions reduced cardiovascular morbidity and mortality . Additionally, there is evidence to suggest that once high BP is controlled in screened individuals, there is improvement in quality of life and work absenteeism . However, there are no standardized approaches to assist in the development of community‐based BP screening programs in LRS.…”

“…13 Additionally, there is evidence to suggest that once high BP is controlled in screened individuals, there is improvement in quality of life and work absenteeism. [14][15][16] However, there are no standardized approaches to assist in the development of communitybased BP screening programs in LRS.The systematic reviews from the CTFPHC and USPSTF found scant literature on screening programs in LRS. 10,11 While describing the Canadian landscape, Lindsay and colleagues 5 demonstrated a higher…”