Langford H G
Drugs. 1986;31 Suppl 1:23-8. doi: 10.2165/00003495-198600311-00006.
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.
高血压检测与随访项目是一项随机试验，旨在比较在特殊诊所接受抗高血压治疗的患者与转诊至常规医疗机构的患者的全因死亡率。总体而言，通过阶梯式治疗，全因死亡率显著降低，在最轻度高血压患者中也是如此。这种抗高血压作用的特异性体现在中风死亡比例的相应降低，以及通过时间依赖性协变量分析时死亡率效应的持续性，该分析考虑了患者接受的抗高血压治疗量。根据死亡证明判断，阶梯式治疗可降低心血管疾病和冠心病死亡率。当分析仅限于基线心电图异常者时，阶梯式治疗的益处仍然存在。根据罗斯问卷判断，阶梯式治疗可降低心绞痛和心肌梗死的5年发病率。噻嗪类治疗患者的血清碱性磷酸酶下降，表明对钙平衡有有利影响。八年分析表明，除最年长参与者外，该项目结束后对死亡率的有利影响仍然存在。
