What does this research mean for the field?

The absolute mortality advantage of intensive stepped care for hypertension over referred care persists and increases up to 8.3 years, even after the formal treatment program is discontinued. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to evaluate the long-term effects of intensified treatment on blood pressure and mortality in hypertensive individuals.

April 8, 1988JAMA

Persistence of Reduction in Blood Pressure and Mortality of Participants in the Hypertension Detection and Follow-up Program

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Why the study?

Does intensively treated stepped care reduce long-term mortality compared to referred care in hypertensive patients?

Population

Participants in the Hypertension Detection and Follow-up Program, including subgroups such as white women…

Comparison

Intensively treated stepped care for hypertension vs Referred care (RC) control group

Design

Cohort

Follow-up

Up to 8.3 years

Authors

NSNeil ShulmanUniversity of Hawaiʻi at Mānoa

Discussion

Member takes

Implication

Intensive stepped care may confer lasting mortality benefit post-intervention; extends prior RCT results via long-term cohort follow-up.

Key Points

This study aims to evaluate the long-term effects of intensified treatment on blood pressure and mortality in hypertensive individuals.
Evaluated mortality rates at 6.7 years for stepped care (SC) and referred care (RC) groups.
Conducted a posttrial surveillance study for 8.3 years after treatment ended.
Compared blood pressure control between groups and tracked antihypertensive medication usage.
Mortality rates at 6.7 years were 95.1/1000 for SC vs 116.3/1000 for RC, showing increased mortality benefit for SC.
Blood pressure control was slightly better in SC (86.5 mm Hg, 68% controlled) compared to RC (87.8 mm Hg, 62% controlled).
The mortality advantage for SC persisted and increased during the posttrial period despite reduced medication use.

Structured PICO

Does intensively treated stepped care reduce long-term mortality compared to referred care in hypertensive patients?

Population

Participants in the Hypertension Detection and Follow-up Program (HDFP), including subgroups such as white women and those aged 30 to 49 years at trial entry

Intervention

Intensively treated stepped care (SC) for hypertension

Comparator

Referred care (RC) control group

Outcome

All-cause mortality at 6.7 years and up to 8.3 years (posttrial surveillance)hard clinical

The mortality benefit of intensive stepped care for hypertension persists and increases even after the formal treatment program ends, likely due to regression of hypertensive end-organ changes.

Cite This Study

Neil Shulman (1988) studied this question.

synapsesocial.com/papers/6a1641ef512cb4f7828ea9e4 https://doi.org/10.1001/jama.1988.03720140033030

Topics

Hypertension management

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Persistence of Reduction in Blood Pressure and Mortality of Participants in the Hypertension Detection and Follow-up Program

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Persistence of Reduction in Blood Pressure and Mortality of Participants in the Hypertension Detection and Follow-up Program

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider