Hypertension Detection and Follow-up Program - HDFP


Systematic vs. community therapy for 5-year mortality in hypertension.


To compare systematic antihypertensive therapy with community medical therapy for hypertension.

Study Design

Study Design:

Patients Screened: Not given
Patients Enrolled: 10,940
Mean Follow Up: 8.3 years

Patient Populations:

Diastolic BP > 90 mm Hg

Primary Endpoints:

5-year mortality

Drug/Procedures Used:

Intensively treated stepped care (SC) (Chlorthalidone/ triamterene / spironolactone; reserpine/methyldopa; hydralazine; guanethedine) vs referred care (RC).

Principal Findings:

Five-year mortality was reduced by 17% in the stepped-care group (6.4%) compared to controls (7.7%).

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. 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.


Stepped therapy was associated with better long-term mortality than community approaches to care. While newer antihypertensive agents may change the direct applicability of this regimen, the use of standardized "levels" of antihypertensive therapy forms the foundation for clinical practice guidelines.


1. JAMA 1979;242:2562-71. Final result (Five-year findings)
2. JAMA 1988;259(14):2113-22. Long-term follow-up

Clinical Topics: Prevention, Statins, Hypertension

Keywords: Methyldopa, Hydralazine, Chlorthalidone, Sympatholytics, Reserpine, Diuretics, Blood Pressure, Triamterene, Spironolactone, Hypertension, Vasodilator Agents

< Back to Listings