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Cited by 828

The DOI matches its OpenAlex record; 2 of the 2 references it cites were found in a registry or an index.

Implications of Small Reductions in Diastolic Blood Pressure for Primary Prevention

Nancy R. Cook·1995·Archives of Internal Medicine
DOI 10.1001/archinte.155.7.701
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Abstract

OBJECTIVES: To estimate the impact of small reductions in the population distribution of diastolic blood pressure (DBP), such as those potentially achievable by population-wide lifestyle modification, on incidence of coronary heart disease (CHD) and stroke. DESIGN: Published data from the Framingham Heart Study, a longitudinal cohort study, and from the National Health and Nutrition Examination Survey II, a national population survey, were used to examine the impact of a population-wide strategy aimed at reducing DBP by an average of 2 mm Hg in a population including normotensive subjects. SETTING/PARTICIPANTS: White men and women aged 35 to 64 years in the United States. MAIN OUTCOME MEASURES: Incidence of CHD and stroke, including transient ischemic attacks (TIAs). RESULTS: Data from overviews of observational studies and randomized trials suggest that a 2-mm Hg reduction in DBP would result in a 17% decrease in the prevalence of hypertension as well as a 6% reduction in the risk of CHD and a 15% reduction in risk of stroke and TIAs. From an application of these results to US white men and women aged 35 to 64 years, it is estimated that a successful population intervention alone could reduce CHD incidence more than could medical treatment for all those with a DBP of 95 mm Hg or higher. It could prevent 84% of the number prevented by medical treatment for all those with a DBP of 90 mm Hg or higher. For stroke (including TIAs), a population-wide 2-mm Hg reduction could prevent 93% of events prevented by medical treatment for those with a DBP of 95 mm Hg or higher and 69% of events for treatment for those with a DBP of 90 mm Hg or higher. A combination strategy of both a population reduction in DBP and targeted medical intervention is most effective and could double or triple the impact of medical treatment alone. Adding a population-based intervention to existing levels of hypertension treatment could prevent an estimated additional 67,000 CHD events (6%) and 34,000 stroke and TIA events (13%) annually among all those aged 35 to 64 years in the United States. CONCLUSIONS: A small reduction of 2 mm Hg in DBP in the mean of the population distribution, in addition to medical treatment, could have a great public health impact on the number of CHD and stroke events prevented. Whether such DBP reductions can be achieved in the population through lifestyle interventions, in particular through sodium reduction, depends on the results of ongoing primary prevention trials as well as the cooperation of the food industry, government agencies, and health education professionals.

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Metadata

Authors
Cook, N. R.
Venue
Archives of Internal Medicine
Publisher
American Medical Association
Published
1995-04-10
Volume
155
Issue
7
Pages
701-701
ISSN
0003-9926 (ISSN-L)
DOI
10.1001/archinte.155.7.701
OpenAlex
W2044673406
Cited by
828
References
2
FWCI
5.02
Type
journal article
Language
en
Open access
closed

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