Thirty-year survival for black and white hypertensive individuals in the Evans County Heart Study and the Hypertension Detection and Follow-up Program

The Evans County Heart Study (ECHS), initiated in 1960, was one of the first major studies to document cardiovascular disease (CVD) risks for African Americans and Caucasians with elevated blood pressures. In the early 1970s, the Hypertension Detection and Follow-up Program (HDFP), with a site in Georgia (HDFP-GA), was one of the first major studies to demonstrate that treating hypertension with stepped care (SC), vs. referred care (RC), has better short-term outcomes. With this background, study objectives were to evaluate 30-year survival and cardiovascular outcomes of the HDFP-GA and to compare outcomes of these patients with 1,619 hypertensive individuals (30 to 69 years of age) from the ECHS. The HDFP-GA patients included 688 individuals (Black [n = 267]; White [n = 421]) randomized to RC (n = 341) and SC (n = 347). The ECHS was comprised of 733 Black and 886 White hypertensives. All-cause mortality and CVD mortality were assessed in the HDFP-GA and compared with those in the ECHS hypertensives. After 30 years of follow-up, 65.7% of the HDFP-GA cohort had died compared with a similar 65.8% of the ECHS hypertensives. However, CVD mortality rates, while similar for the SC and RC arms, were lower than in the HDFP-GA total study group than the hypertensive participants of ECHS (32.6% vs. 40.3%; P < .001). CVD survival rates for both SC and RC HDFP-GA arms were significantly better than population-based hypertensive individuals in the ECHS, with consistent benefits in all four race-gender groups. These results identify the importance of long-term follow-up of individuals in hypertension studies and trials that include CVD outcomes.