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Hypertension Detection and Follow-up Program Cooperative Group; Neil Shulman, MD; Elbert Tuttle, Jr, MD; George Entwisle, MD; Aristide Apostolides, DVM, PhD; Albert Oberman, MD; Harold W. Schnaper, MD; Edward H. Kass, MD, PhD; James O. Taylor, MD; B. Frank Polk, MD; Jeremiah Stamler, MD; Rose Stamler, MA; Flora Gosch, MD; Nemat O. Borhani, MD; Beth Newman, PhD; Linda Harlan, PhD; Marshall Lee, MD; John W. Jones, MD; Sandra A. Daugherty, MD, PhD; H. A. Tyroler, MD; Curtis G. Hames, MD; Siegfried Heyden, MD; Lawrence M. Slotkoff, MD, PhD; Socrates Fotiu, MD; Herbert G. Langford, MD; John Abernathy, MD; Myra Tyler, MD; Morton H. Maxwell, MD; Andrew J. Lewin, MD; Roger Detels, MD; Reuben Berman, MD; Ronald J. Prineas, MB, BS, PhD; Richard S. Crow, MD; M. Donald Blaufox, MD, PhD; Sylvia Wassertheil-Smoller, PhD; C. Hilmon Castle, MD; Josephine Kasteller, PhD; C. Morton Hawkins, ScD; Charles E. Ford, PhD; Barry R. Davis, MD, PhD; Agostino Molteni, MD, PhD; Kenneth A. Schneider, MD; Edward J. Fitzsimmons, PhD; Ronald J. Prineas, MB, BS,; PhD; Gerald H. Payne, MD, MPH; Thomas P. Blaszkowski, PhD; William J. Zukel, MD; Alvin P. Shapiro, MD; Glenn E. Bartsch, PhD; Kenneth G. Berge, MD; Edward S. Cooper, MD; Edward D. Frohlich, MD; Richard H. Gadsden, PhD; David L. Sackett, MD; Joseph A. Wilber, MD; William J. Zukel, MD; W. McFate Smith, MD, MPH; Walter M. Kirkendall, MD; Curtis L. Meinert, PhD; Louis S. Monk, PhD; Richard D. Remington, PhD; Alvin P. Shapiro, MD; Herbert G. Langford, MD; Jeremiah Stamler, MD; Edward H. Kass, MD, PhD; Harold W. Schnaper, MD; Thomas P. Blaszkowski, PhD; Max Halperin, PhD; William J. Zukel, MD

JAMA. 1988;259(14):2113-2122.

Abstract
The Hypertension Detection and Follow-up Program (HDFP) previously described a significant reduction in five-year, all-cause mortality in its intensively treated stepped care (SC) group relative to its referred care (RC) control group. At the time this finding was described, a proportion of the SC cohort had been treated for periods as long as 6.7 years, but comparable RC and SC mortality data beyond five years were not available. These data, which are described herein, indicate that the 6.7-year life-table mortality rates were 95.1/1000 participants for SC vs 116.3/1000 participants for RC, a larger mortality difference than was observed at five years. This favorable finding for SC extended to all major subgroups, including white women and those aged 30 to 49 years at trial entry. Six months after the close of the treatment trial, a two-year posttrial surveillance study, which extended mortality follow-up to 8.3 years, was conducted. The posttrial use of antihypertensive medication declined in SC and increased in RC participants so that by the end of the posttrial period, there was little difference in the percentages of SC and RC participants taking medication. Control of blood pressure, indicated by mean diastolic blood pressure and by percent of participants with a pressure of 90 mm Hg or less, was slightly better for SC than for RC participants (SC group, 86.5 mm Hg and 68% controlled; RC group, 87.8 mm Hg and 62% controlled). The absolute mortality advantage found at 6.7 years persisted and increased throughout the posttrial period of follow-up despite discontinuation of the formal SC therapy program. It is postulated that regression of hypertensive end-organ changes brought about by the more effective SC treatment caused this favorable outcome.

(JAMA 1988;259:2113-2122)

Author Affiliations
Atlanta: Emory University; Baltimore: University of Maryland; Birmingham: University of Alabama; Boston: Brigham and Women's Hospital and Harvard University Medical School; Chicago: Northwestern University; Davis: University of California; East Lansing: Michigan State University; Evans County, Georgia: Evans County Health Department; Washington, DC: Georgetown University; Jackson: University of Mississippi Medical School; Los Angeles: Cedars-Sinai and UCLA Medical Centers; Minneapolis: Mount Sinai Hospital and University of Minnesota; New York: Albert Einstein College of Medicine; Salt Lake City: University of Utah; Coordinating Center, Houston: The University of Texas School of Public Health; Central Laboratory, Chicago: Northwestern Memorial Hospital; ECG Center, Minneapolis: University of Minnesota; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md; (Chairman), University of Pittsburgh School of Medicine; School of Public Health, University of Minnesota, Minneapolis; Mayo Clinic, Rochester, Minn; Hospital of theUniversity of Pennsylvania, Philadelphia; Alton Ochsner Medical Foundation, New Orleans; Medical University of South Carolina, Charleston; McMaster University Medical Center, Hamilton, Ontario; Georgia Department of Human Resources, Atlanta; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.; (Chairman), University of California-USPHS Hospital, San Francisco; The University of Texas Health Science Center and School of Medicine, Houston; School of Hygiene and Public Health, The Johns Hopkins University, Baltimore; Silver Spring, Md; University of lowa, Iowa City; University of Pittsburgh School of Medicine; University of Mississippi Medical Center, Jackson; Northwestern University Medical School, Chicago; Brigham and Women's Hospital and Harvard University Medical School, Boston; University of Alabama at Birmingham; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md; George Washington University, Bethesda, Md; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.

From the Hypertension Detection and Follow-up Program, Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.4

Footnotes
Members of the ad hoc committee that prepared this manuscript on behalf of the HDFP Cooperative Group were as follows: Sandra A. Daugherty, MD, PhD (University of Nevada, Reno); Charles E. Ford, PhD (The University of Texas School of Public Health, Houston); J. David Curb, MD (National Institute on Aging, Bethesda, Md); Herbert Langford, MD (University of Mississippi Medical Center, Jackson); James O. Taylor, MD (Harvard Medical School, Boston); Gerald H. Payne, MD (National Heart, Lung, and Blood Institute, Bethesda, Md); Nemat O. Borhani, MD (University of California at Davis); Sara Pressel, MS, and C. Morton Hawkins, ScD (The University of Texas School of Public Health, Houston).

Reprint requests to Coordinating Center for Clinical Trials, The University of Texas School of Public Health, 1200 Herman Pressler St, Suite 801, Houston, TX 77030 (Charles E. Ford, PhD).

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