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January 8, 1997, Vol 277, No. 2 >
ARTICLE | January 8, 1997

The Hypertension Detection and Follow-up Program: Title and subTitle Break17 Years On FREE

Lawrence E. Ramsay, MB ChB, FRCP
[+] Author Affiliations

A commentary on Hypertension Detection and Follow-up Program Cooperative Group. Five-year findings of the Hypertension Detection and Follow-up Program, I: reduction in mortality of persons with high blood pressure, including mild hypertension. JAMA. 1979;242:2562-2571.

Reprints: Professor L. E. Ramsay, Section of Clinical Pharmacology and Therapeutics, Department of Medicine and Pharmacology, L Floor, Royal Hallamshire-Hospital, Glossop Road, Sheffield S10 2JF, England.


JAMA. 1997;277(2):167-170. doi:10.1001/jama.1997.03540260081041
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References

The Hypertension Detection and Follow-up Program (HDFP)1 was a remarkable feat of clinical investigation that tackled an important question. The study design was a gamble—a $60 million gamble2—that paid off. A respectable difference in diastolic blood pressure (DBP) between stepped care (SC) and referred care (RC) groups was crucial for this massive undertaking to succeed. In fact, the net DBP difference was "only" 5 to 6 mm Hg over the 5 years, but we now know that this is identical to the net DBP difference in all conventionally designed controlled trials of antihypertensive drugs.3 Allcause mortality, the principal end point, was reduced in all SC subjects by 17% (P<.01), and by 20% (P<.01) in those with initial DBP of 90 to 104 mm Hg. Treatment of 66 subjects with DBP 90 to 104 mm Hg for 5 years prevented 1 death, a return that compares favorably

REFERENCES

1 +
Hypertension Detection and Follow-up Program Cooperative Group.  Five-year findings of the Hypertension Detection and Follow-up Program, I: reduction in mortality of persons with high blood pressure, including mild hypertension . JAMA . 1979;;242:2562-2571.
2 +
Relman AS.  Mild hypertension: no more benign neglect . N Engl J Med . 1980;;302:293-294.
3 +
Collins R, Peto R, MacMahon S, et al.  Blood pressure, stroke and coronary heart disease, part 2, short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context . Lancet . 1990;;335:827-838.
4 +
Hypertension Detection and Follow-up Program Cooperative Group.  Five-year findings of the Hypertension Detection and Follow-up Program, III: reduction in stroke incidence among persons with high blood pressure . JAMA . 1982;;247:633-638.
5 +
Hypertension Detection and Follow-up Program Cooperative Group.  Five-year findings of the Hypertension Detection and Follow-up Program, II: mortality by race-sex and age . JAMA . 1979;;242:2572-2577.
6 +
Hypertension Detection and Follow-up Program Cooperative Group.  The effect of treatment on mortality in 'mild' hypertension: results of the Hypertension Detection and Follow-up Program . N Engl J Med . 1982;;307:976-980.
7 +
Hypertension Detection and Follow-up Program Cooperative Group.  Effect of stepped care treatment on the incidence of myocardial infarction and angina pectoris: 5-year findings of the Hypertension Detection and Follow-up Program . Hypertension . 1984;;6( (suppl 1) ):I-198-I-206.
8 +
Maxwell MH, Ford CE, on behalf of the Hypertension Detection and Follow-up Program Cooperative Group.  Cardiovascular morbidity and mortality in HDFP patients 50-69 years old at entry . J Cardiovasc Pharmacol . 1985;;7 ( (suppl 2) ):S5-S9.
9 +
The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure.  The 1984 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure . Arch Intern Med . 1984;;144:1045-1057.
10 +
Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure.  The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V) . Arch Intern Med . 1993;;153:154-183.
11 +
Moser M.  Historical perspective on the management of hypertension . Am J Med . 1986;;80( (suppl 5B) ):1-11.
12 +
Burt VL, Whelton P, Roccella EJ, et al.  Prevalence of hypertension in the US adult population: results from the third National Health and Nutrition Examination Survey, 1988-1991 . Hypertension . 1995;;25:305-313.
13 +
Kass EH.  Special clinics for hypertension: the role of the Hypertension Detection and Follow-up Programme . Br J Clin Pharmacol . 1982;;13:81-86.
14 +
Borhani NO, Langford H, Hawkins CM, Curb JD, for the Hypertension Detection and Follow-up Program Cooperative Group.  Treatment for 'mild hypertension.' N Engl J Med . 1983;;308:524-525.
15 +
Moser M, Gifford RW.  Why less severe degrees of hypertension should be treated . J Hypertens . 1985;;3:437-447.
16 +
Langford HG.  Should hypertension be treated? a guide for the perplexed . J Hypertens . 1986;;4( (suppl 5) ):S533-S536.
17 +
Blaufox MD.  Should mild hypertension be treated? yes . J Hypertens . 1986;;4( (suppl 5) ):S541-S544.
18 +
Freis ED.  Should mild hypertension be treated? N Engl J Med . 1982;;307:306-309.
19 +
Gove S, Hulley SB.  Treatment for 'mild' hypertension . N Engl J Med . 1983;;308:524-525.
20 +
McAlister NH.  Should we treat 'mild' hypertension? JAMA . 1983;;249:379-382.
21 +
Pickering TG.  Treatment of mild hypertension and the reduction of cardiovascular mortality: the 'of or by' dilemma . JAMA . 1983;;249:399-400.
22 +
Ramsay LE.  Mild hypertension: treat patients, not populations . J Hypertens . 1985;;3:449-455.
23 +
Perry HM.  The evolution of antihypertensive therapy . Am J Cardiol . 1985;;56:75H-80H.
24 +
Hampton JR.  Evidence suggesting that mild hypertension need not be treated . J Hypertens . 1986;;4( (suppl 5) ):S528-S532.
25 +
Reader R, Bauer GE, Doyle AE, et al, on behalf of the Management Committee.  The Australian Therapeutic Trial in Mild Hypertension . Lancet . 1980;;1:1261-1267.
26 +
Madhavan S, Alderman MH.  The potential effect of blood pressure reduction on cardiovascular disease . Arch Intern Med . 1981;;141:1583-1586.
27 +
Multiple Risk Factor Intervention Trial Research Group.  Multiple Risk Factor Intervention Trial: risk factor changes and mortality results . JAMA . 1982;;248:1465-1477.
28 +
Hardy RJ, Hawkins CM.  The impact of selected indices of antihypertensive treatment on all-cause mortality . Am J Epidemiol . 1982;;117:566-574.
29 +
Ramsay LE, Haq IU, Yeo WW, Jackson PR. Interpretation of prospective trials in hypertension: do treatment guidelines accurately reflect current evidence? J Hypertens. In press.
30 +
Fahey TP, Peters TJ.  What constitutes controlled hypertension? patientbased comparison of hypertension guidelines . BMJ . 1996;;313:93-96.
31 +
Medical Research Council Working Party.  MRC trial of treatment of mild hypertension: principal results . BMJ . 1985;;291:97-104.
32 +
Peart S, Barnes GR, Brennan PJ, et al, on behalf of the Medical Research Council Working Party.  Stroke and coronary heart disease in mild hypertension: risk factors and the value of treatment . BMJ . 1988;;296:1565-1570.
33 +
Hoes AW, Grobbee DE, Lubson J.  Does drug treatment improve survival? reconciling the trials in mild-to-moderate hypertension . J Hypertens . 1995;;13:805-811.
34 +
Egger M, Davey Smith G.  Risks and benefits of treating mild hypertension: a misleading meta-analysis? J Hypertens . 1995;;13:813-815.
35 +
Johannesson M.  The cost effectiveness of hypertension treatment in Sweden . Pharmacoeconomics . 1995;;7:242-250.
36 +
Neaton JD, Grimm RH, Prineas RJ, et al, on behalf of the Treatment of Mild Hypertension Study Research Group.  Treatment of mild hypertension study: final results . JAMA . 1993;;270:713-724.
37 +
Moser M, Hebert PR.  Prevention of disease progression, left ventricular hypertrophy and congestive heart failure in hypertension treatment trials . J Am Coll Cardiol . 1996;,27:1214-1218.
38 +
Jackson R, Barham P, Bills J, et al.  Management of raised blood pressure in New Zealand: a discussion document . BMJ . 1993;;307:107-110.
39 +
Core Services Committee. Guidelines for the Management of Mildly Raised Blood Pressure in New Zealand . Wellington, New Zealand: Core Services Committee, Ministry of Health; 1995;.
40 +
Weber MA, Laragh JH.  Hypertension: steps forward and steps backward: the Joint National Committee fifth report . Arch Intern Med . 1993;;153:149-152.

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1 +
Hypertension Detection and Follow-up Program Cooperative Group.  Five-year findings of the Hypertension Detection and Follow-up Program, I: reduction in mortality of persons with high blood pressure, including mild hypertension . JAMA . 1979;;242:2562-2571.
2 +
Relman AS.  Mild hypertension: no more benign neglect . N Engl J Med . 1980;;302:293-294.
3 +
Collins R, Peto R, MacMahon S, et al.  Blood pressure, stroke and coronary heart disease, part 2, short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context . Lancet . 1990;;335:827-838.
4 +
Hypertension Detection and Follow-up Program Cooperative Group.  Five-year findings of the Hypertension Detection and Follow-up Program, III: reduction in stroke incidence among persons with high blood pressure . JAMA . 1982;;247:633-638.
5 +
Hypertension Detection and Follow-up Program Cooperative Group.  Five-year findings of the Hypertension Detection and Follow-up Program, II: mortality by race-sex and age . JAMA . 1979;;242:2572-2577.
6 +
Hypertension Detection and Follow-up Program Cooperative Group.  The effect of treatment on mortality in 'mild' hypertension: results of the Hypertension Detection and Follow-up Program . N Engl J Med . 1982;;307:976-980.
7 +
Hypertension Detection and Follow-up Program Cooperative Group.  Effect of stepped care treatment on the incidence of myocardial infarction and angina pectoris: 5-year findings of the Hypertension Detection and Follow-up Program . Hypertension . 1984;;6( (suppl 1) ):I-198-I-206.
8 +
Maxwell MH, Ford CE, on behalf of the Hypertension Detection and Follow-up Program Cooperative Group.  Cardiovascular morbidity and mortality in HDFP patients 50-69 years old at entry . J Cardiovasc Pharmacol . 1985;;7 ( (suppl 2) ):S5-S9.
9 +
The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure.  The 1984 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure . Arch Intern Med . 1984;;144:1045-1057.
10 +
Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure.  The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V) . Arch Intern Med . 1993;;153:154-183.
11 +
Moser M.  Historical perspective on the management of hypertension . Am J Med . 1986;;80( (suppl 5B) ):1-11.
12 +
Burt VL, Whelton P, Roccella EJ, et al.  Prevalence of hypertension in the US adult population: results from the third National Health and Nutrition Examination Survey, 1988-1991 . Hypertension . 1995;;25:305-313.
13 +
Kass EH.  Special clinics for hypertension: the role of the Hypertension Detection and Follow-up Programme . Br J Clin Pharmacol . 1982;;13:81-86.
14 +
Borhani NO, Langford H, Hawkins CM, Curb JD, for the Hypertension Detection and Follow-up Program Cooperative Group.  Treatment for 'mild hypertension.' N Engl J Med . 1983;;308:524-525.
15 +
Moser M, Gifford RW.  Why less severe degrees of hypertension should be treated . J Hypertens . 1985;;3:437-447.
16 +
Langford HG.  Should hypertension be treated? a guide for the perplexed . J Hypertens . 1986;;4( (suppl 5) ):S533-S536.
17 +
Blaufox MD.  Should mild hypertension be treated? yes . J Hypertens . 1986;;4( (suppl 5) ):S541-S544.
18 +
Freis ED.  Should mild hypertension be treated? N Engl J Med . 1982;;307:306-309.
19 +
Gove S, Hulley SB.  Treatment for 'mild' hypertension . N Engl J Med . 1983;;308:524-525.
20 +
McAlister NH.  Should we treat 'mild' hypertension? JAMA . 1983;;249:379-382.
21 +
Pickering TG.  Treatment of mild hypertension and the reduction of cardiovascular mortality: the 'of or by' dilemma . JAMA . 1983;;249:399-400.
22 +
Ramsay LE.  Mild hypertension: treat patients, not populations . J Hypertens . 1985;;3:449-455.
23 +
Perry HM.  The evolution of antihypertensive therapy . Am J Cardiol . 1985;;56:75H-80H.
24 +
Hampton JR.  Evidence suggesting that mild hypertension need not be treated . J Hypertens . 1986;;4( (suppl 5) ):S528-S532.
25 +
Reader R, Bauer GE, Doyle AE, et al, on behalf of the Management Committee.  The Australian Therapeutic Trial in Mild Hypertension . Lancet . 1980;;1:1261-1267.
26 +
Madhavan S, Alderman MH.  The potential effect of blood pressure reduction on cardiovascular disease . Arch Intern Med . 1981;;141:1583-1586.
27 +
Multiple Risk Factor Intervention Trial Research Group.  Multiple Risk Factor Intervention Trial: risk factor changes and mortality results . JAMA . 1982;;248:1465-1477.
28 +
Hardy RJ, Hawkins CM.  The impact of selected indices of antihypertensive treatment on all-cause mortality . Am J Epidemiol . 1982;;117:566-574.
29 +
Ramsay LE, Haq IU, Yeo WW, Jackson PR. Interpretation of prospective trials in hypertension: do treatment guidelines accurately reflect current evidence? J Hypertens. In press.
30 +
Fahey TP, Peters TJ.  What constitutes controlled hypertension? patientbased comparison of hypertension guidelines . BMJ . 1996;;313:93-96.
31 +
Medical Research Council Working Party.  MRC trial of treatment of mild hypertension: principal results . BMJ . 1985;;291:97-104.
32 +
Peart S, Barnes GR, Brennan PJ, et al, on behalf of the Medical Research Council Working Party.  Stroke and coronary heart disease in mild hypertension: risk factors and the value of treatment . BMJ . 1988;;296:1565-1570.
33 +
Hoes AW, Grobbee DE, Lubson J.  Does drug treatment improve survival? reconciling the trials in mild-to-moderate hypertension . J Hypertens . 1995;;13:805-811.
34 +
Egger M, Davey Smith G.  Risks and benefits of treating mild hypertension: a misleading meta-analysis? J Hypertens . 1995;;13:813-815.
35 +
Johannesson M.  The cost effectiveness of hypertension treatment in Sweden . Pharmacoeconomics . 1995;;7:242-250.
36 +
Neaton JD, Grimm RH, Prineas RJ, et al, on behalf of the Treatment of Mild Hypertension Study Research Group.  Treatment of mild hypertension study: final results . JAMA . 1993;;270:713-724.
37 +
Moser M, Hebert PR.  Prevention of disease progression, left ventricular hypertrophy and congestive heart failure in hypertension treatment trials . J Am Coll Cardiol . 1996;,27:1214-1218.
38 +
Jackson R, Barham P, Bills J, et al.  Management of raised blood pressure in New Zealand: a discussion document . BMJ . 1993;;307:107-110.
39 +
Core Services Committee. Guidelines for the Management of Mildly Raised Blood Pressure in New Zealand . Wellington, New Zealand: Core Services Committee, Ministry of Health; 1995;.
40 +
Weber MA, Laragh JH.  Hypertension: steps forward and steps backward: the Joint National Committee fifth report . Arch Intern Med . 1993;;153:149-152.

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