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The Hypertension Detection and Follow-up Program (HDFP) reported a significant reduction in 5 year mortality from all causes in its intensively treated stepped care group compared with its referred care group (p less than .01). In stratum I (mean baseline diastolic blood pressure 90 to 104 mm Hg) mortality in the stepped care group was 20.3% lower than that in the referred care group (p less than .01). For persons in this stratum not on antihypertensive drugs at baseline and free of major target organ damage, mortality in the stepped care group was 28.6% lower than that in the referred care group (p less than .01). Publication of the results of Multiple Risk Factor Intervention Trail (MRFIT), indicating possibly increased mortality in special intervention hypertensive participants with resting electrocardiographic (ECG) abnormalities, prompted further analyses of the HDFP data to determine whether stepped care drug treatment in stratum I patients with resting ECG abnormalities was associated with a similar outcome. Of the 7825 HDFP participants in stratum I, 5173 met MRFIT eligibility criteria and qualified as a subgroup comparable to the MRFIT "mild" hypertensives, 1963 with and 3210 without evidence of resting ECG abnormalities at baseline. In the subgroup without resting ECG abnormalities, mortality rates for coronary heart disease, major cardiovascular diseases, and for all causes were consistently lower in the stepped care group than in the referred care group. This finding was consistent with the MRFIT results.(ABSTRACT TRUNCATED AT 250 WORDS)

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The effect of antihypertensive drug treatment on mortality in the presence of resting electrocardiographic abnormalities at baseline: the HDFP experience. The Hypertension Detection and Follow-up Program Cooperative Research Group.