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Mortality findings beyond five years in the hypertension detection and follow‐up program (HDFP)

The primary objective of the Hypertension Detection and Follow-up Program (HDFP) was to determine, in a community-based population of hypertensive subjects, the effect on 5-year all-cause mortality of standardized intensive drug treatment, designated stepped care, compared with the usual community care, designated referred care. Hypertensive subjects were screened from a base population of 159000 black and white men and women aged 30–69 years, identified from 14 United States communities, and randomly allocated to stepped and referred care groups according to baseline diastolic blood pressure (DBP) strata: stratum I, DBP 90–104 mmHg; stratum II, DBP 105 ± 114 mmHg; stratum III, DBP ± 115 mmHg. The treatment period was designed to last 5 years, and 5-year mortality results have been published previously. However, since the 10940 participants were recruited over a 14-month period, and treatment extended approximately 6 months beyond the end of the 5th year of the last enrolled participant, most were treated for 6 or more years before the study was terminated. A 2-year post-trial surveillance study in the HDFP population provided an opportunity to determine mortality rates in the stepped and referred care groups for 6.7 years. These data show that the mortality advantage of stepped care persisted beyond 5 years and was even greater after 6.7 years. Moreover, a stepped care advantage was demonstrated in all major population subgroups, including all four race-sex groups, all age groups and all three DBP strata. The 6.7-year all-cause mortality rates were 95.1/1000 for stepped care and 116.3/1000 for referred care (P < 0.01), compared with 5-year mortality rates of 63.9/1000 for stepped care and 77.3/1000 for referred care (P < 0.01). There were also statistically significant differences (P < 0.05) in the 6.7-year death rates for stroke (stepped care 6.8/1000 versus referred care 11.5/1000) and for myocardial infarction (13.9/1000 versus 18.8/1000). These data add to our previously reported 5-year findings and support our conclusion that systematic effective treatment of hypertension reduced mortality in HDFP participants regardless of race, sex, age or DBP.