164 ABSTRACTS: HIGH BLOOD PRESSURE CONTROL

A-87 MHiPAGING THE HYPERTENSIVE PATIENT IN PRIMARY PRACTICE: CAN WE DO ANY BETTER?

J. George Fodor, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada, AlB 3V6; Patricia L. Bruce-Lockhart

A quasi-experimental project testing the efficacy of a special intervention program of hypertension control for a total community contrasted with a reference community has now been in effect in Newfoundland for eighteen months. Data regarding the efficacy of detection, diagnostic work-up and decisions regarding therapeutic management will be presented for each community. Both the reference and study communities, separated geographically by 200 miles, are similar in terms of adult population composition: females outnumber males in both towns (reference community = 51%; study community = 52%), while the mean adult ages are also comparable (41.3 years versus 42.1 years, respectively). The reference and study centers are each predominantly white, English-speaking and semi-industralized. Mortality figures, however, reveal a significant difference between the reference and study communities, with ischemic heart disease and acute cerebrovascular events being more frequently reported in the study community. Experience with 85% of family physicians in the study community (each group managing a cohort of 300 randomly selected hypertensives for one year) will be described. Emphasis will center on differences between communities in adopting methods for hypertension risk management and its implications for long-term control and secondary prevention.

A-88 HYPERTENSION AS A PUBLIC HEALTH PROBLEM IN THE NETHERLANDS

J. Geerling, Health Council of the Netherlands, Rijswijk, Holland.

The Netherlands Health Council ("Gezondheidsraad") is an independent body of expert panels, which inform and advise the Government, and especially the Secretary of Public Health and Environment, on medical and ecological items. In 1975 the Ministry requested information and recommendations about epidemiology, etiology, detection and therapy of hypertension. A panel, consisting of cardiologists, internists, epidemiologists, family doctors and officers of public health defined hypertension, set rules for the standardization of indirect blood pressure measurement and collected epidemiological data. It was concluded that in 20% of the population aged 30 to 60 years some sort of blood pressure elevation is found, mild in 15%, more severe in the remainder. Awareness and treatment of hypertension are very unsatisfactory at present, particularly in view of the fact that we deal with a cardiovascular risk factor of considerable importance, which, moreover, can be modified by intervention. The panel recommended hygienic measures (such as salt restriction and weight reduction) for everybody with hypertension and medical treatment for those with consistent diastolic pressure exceeding 105 mm of mercury. In the Dutch setting detection of Hypertension should be a task for the family doctor in the first place. Other detec.cion-models are considered complementary and should be subjected to further research. The panel ?lso recommended investigations into the field of patient and doctor compliance, salt intake and the influence of stress.