January 8, 1997

The Hypertension Detection and Follow-up Program17 Years On

Author Affiliations

From the Section of Clinical Pharmacology and Therapeutics, Department of Medicine and Pharmacology, Royal Hallamshire Hospital, Sheffield, England.

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

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