[Therapeutic use of lowering blood pressure, especially in mild hypertension. Results of a hypertension detection and treatment program].

The results of the Hypertension Detection and Follow-up Program (HDFP), one of the largest hypertension intervention trials will be reported. 5,485 hypertensives received systematic antihypertensive drug therapy (stepped care) and 5,455 were referred to community medical therapy (referred care) with less intensive treatment. In contrast to other hypertension intervention studies, HDFP did not have any exclusion criteria. The results of the HDFP confirmed that intensive antihypertensive therapy can significantly lower the five-year mortality from all causes of all hypertensive patients. This is also true for the range of mild hypertension (diastolic blood pressure (DBP) 90-104 mm Hg): reduction in all cause mortality by 20.3%. A reduction of the average DBP in this mild range to 83.4 mm Hg was achieved, which is much lower than 90 mm Hg, usually recommended. The reduction of mortality included a decrease of the stroke and myocardial infarction rate, which reached nearly 50% among mild hypertensives of the stepped care group in comparison to the referred care group. Incidences of nonfatal stroke, myocardial infarction, angina pectoris und left ventricular hypertrophy could also be lowered. The best results were achieved if therapy was started early, before end-organ-damage was present. On the other hand, antihypertensive therapy was of benefit in patients with end-organ-damage and in the elderly. The noncardiovascular mortality was also reduced, which was due to improvement of cardiac reserve under antihypertensive therapy. The side effects of drug treatment have been within the known range and did not negate the therapeutic benefit.