Endemic hypertension was discovered in a biosocial assessment of the Black population of Holmes County, a poor, rural community in central Mississippi. In order to find ways of treating a disease of this magnitude at the community level, a small-scale detection and control program was undertaken in the Spring of 1972 and lasted about 17 months. Despite numerous constraints (lack of full-time medical professionals and a 769 sq. mile area of coverage), working essentially outside the existing health care system (although local physicians did accept referral patients), and relying primarily on an indigenous staff, it was possible to screen over 4200 persons 5 yr and older in their homes (of which 1100 had blood pressure readings of 160 95 or greater), refer almost half of those with elevated blood pressures (over 500) to a make-shift clinic where simplified diagnostic evaluations were performed, and follow a small group of hypertensives who were put on treatment (about 100) for over 1 yr. This paper details the history of this project, the unusual circumstances under which it operated, the results of the vast quantity of epidemiological and clinical data that were collected, and its implications for initiating a full-scale community intervention program.
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