“HDFP,” Hypertension Detection and Follow-up Program   Sponsor     National Heart, Lung and Blood Institute (NHLBI), U.S. National Institutes of Health (NIH)   Berman Center Co-investigator     Richard Grimm, MD, MPH, PhD   Description     This national, multi-site study, which was conducted between1971 and 1983 (clinical phase from February 1973 to May 1982), enrolled 10,940 participants aged 30-69 with mild hypertension. Participants were randomized to 2 treatment arms, were treated for 5 years, and participated in mortality follow-up for1 year after study intervention. Based on study results, investigators concluded that effective treatment reduces premature deaths by 17% for all hypertension and by 20% for mild hypertension.   Role of the Berman Center     The Berman Center was one of 14 clinical sites. The Berman Center enrolled 800 participants; 98% of Berman Center participants completed the trial. Participants randomized to the stepped-care group (see Abstract for explanation) were treated at the Berman Center.   Abstract     Prior to HDFP it was not known whether or not the benefits from antihypertensive therapy applied to all hypertensives in the general population and whether or not making use of existing medical knowledge could significantly reduce morbidity and mortality from hypertension. HDFP was designed to determine whether a practical, intensive, and antihypertensive program could significantly reduce morbidity and mortality in hypertensives in the general population.     The primary hypothesis tested by HDFP was that intensive blood pressure control under stepped care for five years could significantly reduce mortality compared to that under referred care. The primary endpoint was mortality; secondary and intermediate factors included nosologic codes of specific causes of mortality, nonfatal myocardial infarction, stroke, hypertensive heart disease, and EKG abnormalities.     10,940 male (5,901; 54%) and female (5,039; 46%) participants, ages 30-69, were enrolled in the study between 1973 and 1982. Individuals were enrolled in the study if average home readings and clinic readings of their diastolic blood pressure were equal to or above 95mmHg and 90mmHg, respectively. They were randomized to a stepped-care or referred-care treatment arm, followed under treatment for 5 years, and participated in 1 year mortality follow-up thereafter. Stepped-care was the method of treatment in HDFP clinics, where a diuretic was given initially and additional antihypertensives were added in a time-structured, stepwise fashion until goal blood pressure was achieved. Referred-care was the control group treatment, for which participants were referred to their primary physician or other private physicians and other community sources of care.     HDFP found that effective treatment of hypertension significantly reduced mortality. Specifically, five-year mortality from all causes was 17% lower for stepped-care versus referred-care groups for all participants and 20% lower for the stepped-care participants with mild hypertension (diastolic blood pressure 90-104mmHg) compared with the corresponding referred-care subgroup. Blood pressure control was consistently better for the stepped-care group than for the referred-care group. Reductions in stroke rates among stepped-care participants were experiences for all race-sex groups, diastolic blood pressure strata, and age groups. HDFP informed further clinical research trials in hypertension control, especially for mild hypertension.