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Further analyses of the hypertension detection and follow-up program
Insights
The Hypertension Detection and Follow-up Program demonstrated that stepped care significantly reduced all-cause mortality in hypertensive patients. This benefit, particularly for mild hypertension, persisted long-term, highlighting effective blood pressure management.
Area of Science:
- Cardiology
- Public Health
- Clinical Trials
Background:
- Hypertension is a major risk factor for cardiovascular disease and mortality.
- Effective management strategies are crucial for improving patient outcomes.
- The Hypertension Detection and Follow-up Program (HDFP) aimed to evaluate a structured care approach.
Purpose of the Study:
- To compare the effectiveness of antihypertensive therapy in specialized clinics versus usual care.
- To assess the impact of stepped care on all-cause mortality in hypertensive individuals.
- To investigate the specific effects of stepped care on cardiovascular events and mortality.
Main Methods:
- A randomized trial comparing stepped care in special clinics with usual care.
- Analysis of all-cause mortality, cardiovascular mortality, and specific events like stroke, angina, and myocardial infarction.
- Inclusion of time-dependent covariates to account for therapy received and baseline ECG abnormalities.
Main Results:
- Stepped care significantly reduced overall all-cause mortality, especially in patients with mild hypertension.
- A proportionate reduction in stroke deaths and persistence of mortality benefits were observed.
- Cardiovascular and coronary heart disease mortality decreased, with benefits seen even in patients with baseline ECG abnormalities.
- Reduced incidence of angina pectoris and myocardial infarction in the stepped care group.
- Thiazide treatment led to a fall in serum alkaline phosphatase, suggesting a positive calcium balance effect.
Conclusions:
- Stepped care is an effective strategy for reducing mortality in hypertensive patients.
- The benefits of stepped care extend to cardiovascular events and persist beyond the treatment program.
- This approach offers a significant public health advantage in managing hypertension and its complications.
Abstract:
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.