Hypertension in the Inner City

Sixty-one percent (6480 of 10,564) of the subjects in three census tracts were screened simply and efficiently in supermarkets. The prevalence of hypertension in the subjects over 25 years of age was 24%. Fifty percent (457 of 953) found to be hypertensive on initial screening failed to keep their first verification appointment. The number was reduced to 279 (29%) by personal contact or home visits by one of the cardiovascular group. Subsequent experience demonstrated that dropouts could be reduced to under 5% by scheduling the verification visit 24-48 hours after initial screening. At the second verification visit there were originally 108 "no-shows" which could be reduced to 36 by personal contact. Because of a fall in diastolic blood pressure below 90 mm Hg during the two verification visits, 296 patients were excluded from the study. Of the 953 initially hypertensive subjects, 284 (30%) were available for study. These patients were randomized into three groups, a stepped-up care group (group A) and two usual medical care groups (groups B and C). Of the original 98 patients, 84% are currently being followed in group A, whereas only 33% in group B and 17% in group C are under medical care. The diastolic blood pressure has returned to normal in 70% in group A, in 10% in group B, and in 17% in group C.