Detection and Treatment of Hypertension in Older Individuals1

The Hypertension Detection and Follow-up Program screened 34,012 individuals aged 60-69 years old in their homes in 14 communities around the United States during 1972 and 1973. The prevalence of hypertension, defined as diastolic blood pressure greater than or equal to 90 mmHg or on antihypertensive medication, was 42.1%. After a second clinic screen, 2,376 hypertensives were identified and randomized into Stepped Care, a special intensive treatment group, or Referred Care, a group referred to their usual medical care sources. These individuals were followed for five years (until they reached the ages of 65-74 years). Over the five years, 79.4% of older individuals remained under active care and 81.4% of those were at their goal diastolic blood pressure. Side-effects tended to be less frequent in older individuals than in younger ones. Older Stepped Care participants with mild hypertension (diastolic blood pressure 90-104 mmHg) had a 17.2% reduction in all-cause mortality over five years compared to Referred Care, which was primarily due to a reduction in deaths attributed to cardiovascular causes. Thus, antihypertensive treatment can be safely and beneficially administered to individuals in this age range with diastolic hypertension, including those with mild hypertension.