George Entwisle

Hypertension incidence in an inner-city black population

Abstract A random sample of the inner-city Baltimore population aged 30–69 yr was screened for hypertension. Three to four years later those individuals who were identified as normotensives (DBP vs (16.1%) with respect to fathers occupation.

A survey of blood pressure in the state of Maryland.

To provide baseline data for a state program to coordinate hypertension resources, a blood pressure (BP) survey was undertaken in Maryland in 1978. A statewide probability sample of households was chosen; each adult member was eligible for interview and measurement of BP. A total of 6,425 adults were interviewed for an overall response rate of 79.5%. Using a definition of diastolic blood pressure (DBP) of 95 mm Hg or higher or use of antihypertensive medication, 15.1% of state residents were estimated to be hypertensive. Of these, 85.8% were estimated to be aware of their condition, 77.6% of them were treated, and 67.6% had their BP controlled to a normal level by medication. Data are also presented using DBP 90 mm Hg or higher. A comparison of data from the Hypertension Detection and Follow-up Program (HDFP) home screen in 1973-1974 and comparable information from this survey showed lower rates of awareness, treatment, and BP control in hypertensives at HDFP home screen. Results of this survey will be compared with those of a second statewide survey conducted four years later to assess changes in rates of hypertension awareness, treatment, and control.

Within-person variability in diastolic blood pressure for a cohort of normotensives☆

Abstract A random sample of 7500 inner-city Baltimore residents was screened for hypertension in their homes during 1973–1974. Three years later 2667 of those found to be normotensive at baseline were re-examined at home. Those with diastolic blood pressure ⩾95 mmHg or who had begun taking antihypertensive medication since baseline were invited to a clinic for further evaluation. A sample of those whose baseline diastolic blood pressure was The within-person standard deviation was 7.8 mmHg for the baseline and follow-up home examinations. The between-occasion standard deviation was 7.4 mmHg and the within-occasion standard deviation was 2.4 mmHg. The between-occasion standard deviation was slightly lower for the 1976–1977 home and clinic examination but the within-occasion standard deviation was about the same. A small systematic decrease was noted between readings on the same occasion.

A study of hypertension in a black urban community: Preliminary epidemiologic findings

Abstract A prevalence survey of blood pressure levels among adult residents in a stratified random sample of central Baltimore City households showed geographical differences in prevalence rates. Variation in prevalence rates was associated with indices of socioeconomic status. High prevalence rates were associated with high rates of manifestation of severe disease. Measurements of end-organ damage and high blood pressure levels were used as manifestations of disease severity. The data describe the total prevalence of high blood pressure whether or not the elevation is under control. It, therefore, provides a complete estimate of the community hypertension burden. Indices of socioeconomic status can, incidentally, describe differential use of, or access to, sources of medical service. Interview data collected prior to initial blood pressure measurement were used to see how prevalence was related to individual perceptions of medical care availability and the use of different sources of medical service. The results of analysis showed an association between blood pressure control and availability of medical care. There was no association between availability of medical care and the proportion of free living hypertensive individuals known to the medical care system. The investigators believe that this preliminary analysis reflects the quality of personal care that goes with availability of medical services and the current mode of clinical practice which has virtually no impact on the identification of asymptomatic hypertensive individuals.

EVALUATION IN HOME CARE SERVICES

Existing and newly developing community resources are frequently designed to provide needed care or support, not otherwise available, to individuals in the community. It is important that the practical value of such community resources be appraised, and with respect to home care services or projects, their practical value is hard to assess because of difhculties associated with the selection and follow-up of an appropriate control group of patients.