Further analyses of the hypertension detection and follow-up program.

The Hypertension Detection and Follow-up Program was a randomised trial to compare all-cause mortality of patients receiving antihypertensive therapy in special clinics with those referred to the usual sources of care. All-cause mortality was significantly reduced overall, and in the mildest hypertensives, by stepped care. This specificity of the antihypertensive effect was shown by the proportionate lowering of stroke deaths, and the persistence of the mortality effect, when analysed by time-dependent co-variants, which took into account the amount of antihypertensive therapy the patients were receiving. Cardiovascular and coronary heart disease mortality were reduced in stepped care, as judged by death certificates. The benefits of stepped care were still present when analyses were confined to those with baseline ECG abnormalities. The 5-year incidence of angina pectoris and myocardial infarction, as judged by the Rose Questionnaire, was decreased in stepped care. Serum alkaline phosphatase fell in thiazide treated patients, suggesting a favourable influence on calcium balance. Eight-year analyses suggest that the favourable influence on mortality persisted after the end of the program for all except the eldest participants.