Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Trends and social factors in blood pressure control in Scottish MONICA surveys 1986–1995: the rule of halves revisited

An Erratum to this article was published on 23 September 2004

Abstract

Time trends and social factors in detection, treatment and control of hypertension in the community were examined in four independent Scottish MONICA cross-sectional surveys in 1986, 1989, 1992 and 1995. Residents aged 25–64 years were recruited randomly from general practice lists in north Glasgow, Scotland with stratification by sex and 10-year age groups. A total of 1262 participated in the first survey, 1397 in the second, 1516 in the third and 1836 in the fourth. Differences and trends in proportions of hypertension undetected, detected but untreated, treated but uncontrolled and controlled across the four surveys were tested by χ2, and the associations of the poor control of hypertension with social factors were estimated by multivariate logistic regression model to derive odds ratios. Using the cut point of 160/95 mmHg, proportion of hypertension undetected across the four surveys was 56.3, 44.6, 32.0 and 38.2%, and of treated controlled hypertension was 15.2, 26.4, 32.0 and 32.8% (both trends P<0.001). Multivariate analysis showed that poor control of hypertension was not related to social deprivation, but significantly related to being male, young, of low body mass index and heavy alcohol drinking. Undetected hypertension was significantly related to full-time employment, and untreated hypertension to high social class and possibly education level. These findings suggest that in this part of Scotland the management of hypertension has improved, so the ‘rule of halves’ no longer applies. Control of blood pressure is not positively associated with social deprivation, but people at a high risk of poor control of hypertension should be targeted.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Wilber JA, Barrow JH . Hypertension: a community problem. Am J Med 1972; 52: 653–663.

    Article  CAS  PubMed  Google Scholar 

  2. Smith WCS, Lee AJ, Crombie IK, Tunstall-Pedoe H . Control of blood pressure in Scotland: the rule of halves. BMJ 1990; 300: 981–983.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. WHO MONICA Project Principal Investigators (prepared by Tunstall-Pedoe H). The World Health Organization MONICA Project (Monitoring Trends and Determinants in Cardiovascular Diseases): a major international collaboration. J Clin Epidemiol 1988; 41: 105–114.

  4. Kuulasmaa K, Hense HW, Tolonen H for the WHO MONICA Project. Quality assessment of data on blood pressure in the WHO MONICA Project (May 1998). Available from URL: http://www.ktl.fi/publications/monica/bp/bpqa.htm, URN:NBN:fi-fe19991082.

  5. Carstairs V, Morris R . Deprivation and Health in Scotland. Aberdeen University Press: Aberdeen, 1991.

    Google Scholar 

  6. Guidelines Subcommittee. 1999 World Health Organisation—International Society of Hypertension guidelines for the management of hypertension. J Hypertens 1999; 17: 151–183.

  7. British Hypertension Society Working Party. Treating mild hypertension. BMJ 1989; 298: 694–698.

  8. Pickering TG . Blood pressure measurement and detection of hypertension. Lancet 1994; 344: 31–35.

    Article  CAS  PubMed  Google Scholar 

  9. Marques-Vidal P et al. Sex differences in awareness and control of hypertension in France. J Hypertens 1997; 15: 1205–1210.

    Article  CAS  PubMed  Google Scholar 

  10. Colhoun HM, Dong W, Poulter NR . Blood pressure screening, management and control in England: results from the health survey for England 1994. J Hypertens 1998; 16: 747–752.

    Article  CAS  PubMed  Google Scholar 

  11. Henauw SD et al. Trends in the prevalence, detection, treatment and control of arterial hypertension in the Belgian adult population. J Hypertens 1998; 16: 277–284.

    Article  PubMed  Google Scholar 

  12. Vargas CM, Ingram DD, Gillum RF . Incidence of hypertension and educational attainment. The NHANES I Epidemiologic Followup Study. Am J Epidemiol 2000; 152: 272–278.

    Article  CAS  PubMed  Google Scholar 

  13. Birkette NJ, Donner AP, Maynard MD . Assessing hypertension control in the community: the need for follow-up measurements to ensure clinical relevance. Can Med Assoc J 1987; 136: 595–600.

    Google Scholar 

  14. Folsom AR et al. Improvement in hypertension detection and control from 1973–1974 to 1980–1981. The Minnesota Heart Survey Experience. JAMA 1983; 250: 916–921.

    Article  CAS  PubMed  Google Scholar 

  15. Fodor JG, Chalati B, Syed AS, Chockalingam A . Changes in the patterns of blood pressure treatment in North America from 1960 to 1990. J Hum Hypertens 1993; 7: 539–541.

    CAS  PubMed  Google Scholar 

  16. Burt VL et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the Health Examination Surveys, 1960 to 1991. Hypertension 1995; 26: 60–69.

    Article  CAS  PubMed  Google Scholar 

  17. Nissinen A et al. Ten-year results of hypertension care in the community: follow-up of the North Karelia hypertension control program. Am J Epidemiol 1988; 127: 488–499.

    Article  CAS  PubMed  Google Scholar 

  18. Heller RF . Detection and treatment of hypertension in an inner London community. Br J Prev Soc Med 1976; 30: 268–271.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Kurji KH, Haines AP . Detection and management of hypertension in general practices in north west London. Br Med J Clinic Res Ed 1984; 288: 903–906.

    Article  CAS  Google Scholar 

  20. Marques-Vidal P, Tuomilehto J . Hypertension awareness, treatment, and control in the community: is the ‘rule of halves’ still valid? J Hum Hypertens 1997; 11: 213–220.

    Article  CAS  PubMed  Google Scholar 

  21. Seccareccia F, Menotti A, Prati PL . Coronary heart disease prevention: relationship between socio-economic status and knowledge, motivation and behaviour in a free-living male, adult population. Eur J Epidemiol 1991; 7: 166–170.

    Article  CAS  PubMed  Google Scholar 

  22. Swales JD . Current status of hypertensive disease treatment: results from the evaluation and interventions for systolic blood pressure elevation: regional and global (EISBERG) project. J Hypertens Suppl 1999; 17: S15–S19.

    Article  CAS  PubMed  Google Scholar 

  23. Lang T, Pariente P, Salem G, Tap D . Social, professional conditions and arterial hypertension: an epidemiological study in Dakar, Senegal. J Hypertens 1988; 6: 271–276.

    Article  CAS  PubMed  Google Scholar 

  24. Plans P, Pardell H, Salleras L . Epidemiology of cardiovascular disease risk factors in Catalonia (Spain). Eur J Epidemiol 1993; 9: 381–389.

    Article  CAS  PubMed  Google Scholar 

  25. Wagner EH et al. The Edgecombe County high blood pressure control program: I. Correlates of uncontrolled hypertension at baseline. Am J Public Health 1984; 74: 237–242.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Pica LA, Boucher MM, Grignon R . The prevalence, awareness and control of hypertension in Laval, Québec, 1986. Can J Public Health 1990; 81: 427–430.

    CAS  PubMed  Google Scholar 

  27. Nieto FJ et al. Population awareness and control of hypertension and hypercholoesterolemia. Arch Intern Med 1995; 155: 677–684.

    Article  CAS  PubMed  Google Scholar 

  28. Vezù L, La Vecchia L, Vincenzi M . Hypertension, obesity and response to antihypertensive treatment: results of a community survey. J Hum Hypertens 1992; 6: 215–220.

    PubMed  Google Scholar 

  29. Lang T et al. Relations between alcohol consumption and hypertension prevalence and control in a French population. J Chron Dis 1987; 40: 713–720.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The study was funded by the Scottish Executive Chief Scientist Office and the British Heart Foundation. Views expressed are those of the authors and not necessarily of the funding bodies.

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to R Chen or H Tunstall-Pedoe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chen, R., Tunstall-Pedoe, H., Morrison, C. et al. Trends and social factors in blood pressure control in Scottish MONICA surveys 1986–1995: the rule of halves revisited. J Hum Hypertens 17, 751–759 (2003). https://doi.org/10.1038/sj.jhh.1001612

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1001612

Keywords

This article is cited by

Search

Quick links