Mortality findings for stepped-care and referred-care participants in the hypertension detection and follow-up program, stratified by other risk factors

Abstract

Analyses of 5-year mortality data from the Hypertension Detection and Follow-up Program (HDFP) were performed with stratification according to several baseline traits. The HDFP participants were 10,940 white and black men and women ages 30–69 at baseline who were randomized to either stepped-care (SC) or referred-care (RC) groups. All-causes mortality rates were lower for the SC than the RC group, both overall and for the 90–104 mm Hg stratum, for both cigarette smokers and nonsmokers, and for persons with and without hypercholesterolemia, hyperglycemia, diagnosed diabetes, hyperuricemia, or rapid pulse rate. The SC group also fared better than RC for all strata of body mass index, with an apparent trend toward an inverse relationship between body mass index and degree of benefit. Several of the traits—cigarette smoking, fasting hyperglycemia, and hyperuricemia—were associated with significantly higher 5-year mortality rates in both SC and RC participants, in both univariate and multivariate analyses, and a significant U-shaped relationship was recorded between body mass index and mortality for both SC and RC groups. These findings indicate the broad benefit of vigorous antihypertensive stepped-care treatment for hypertensive patients regardless of the presence or absence of the other major risk factors. They also underscore the need for comprehensive management of persons with high blood pressure to control not only their hypertension but also other risk factors associated with negative impact on long-term prognosis.