In the Hypertension Detection and Follow-up Program, 7825 (71.5 per cent) of the 10,940 participants had diastolic blood pressures averaging between 90 and 104 mm Hg on entry into the study and were designated Stratum 1. Half were referred to their usual source of care in the community (the referred-care group), and half were treated intensively in special clinics (the stepped-care group). Five-year mortality in the Stratum 1 patients given stepped care was 20.3 per cent lower than in those given referred care (P<0.01). Particularly noteworthy was the beneficial effect of stepped-care treatment on persons with diastolic pressures of 90 to 104 mm Hg who had no evidence of end-organ damage and were not receiving antihypertensive medication when they entered the study. This subgroup had 28.6 per cent fewer deaths at five years among those treated with stepped care than among those treated with referred care (P<0.01). These findings support a recommendation that in patients with mild hypertension, treatment should be considered early, before damage to end organs occurs. (N Engl J Med. 1982; 307:976–80.) The Hypertension Detection and Follow-up Program was designed to determine whether total mortality among hypertensive people in the community could be reduced by a rigorous stepped-care approach to the treatment of hypertension, as compared with referral to a usual source of care in the community. A total of 10,940 persons aged 30 to 69 with diastolic blood pressures of 90 mm Hg and above were randomized into two groups: half were referred to their usual source of care in the community (the referred-care group), and the other half were treated in the Hypertension Detection and Follow-up Program's clinics, in which.
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