Five-year findings of the Hypertension Detection and Follow-up Program. Prevention and reversal of left ventricular hypertrophy with antihypertensive drug therapy. Hypertension Detection and Follow-up Program Cooperative Group.

Abstract

The Hypertension Detection and Follow-up Program followed 10,940 hypertensive adults for 5 years. Participants were monitored with electrocardiograms (ECGs) and chest x-ray films. Changes in ECG and cardiothoracic ratio were compared between stepped car and the referred care groups. In those with tall R wave by ECG at baseline, who survived the 5-year follow-up, incidence of left ventricular hypertrophy (LVH) by ECG criteria was 4.1% in the stepped care group and 8.6% in the referred care group (p less than 0.01). In those participants with ECG evidence of tall R wave or LVH at baseline, the rate of regression toward normal was 54.3% in the stepped care group and 42.9% in the referred care group (p less than 0.01). Reversal of enlarged cardiac silhouette on chest x-ray film (cardiothoracic ratio greater than or equal to 0.5) occurred in 47% of the stepped care group and in 38% of the referred care group (p less than 0.01). These results indicate that the use of systematic antihypertensive therapy to achieve goal blood pressure reduces the incidence of LVH enlarged cardiac silhouette in adults with hypertension. In addition, it was found that antihypertensive treatment tends to reverse previous LVH or high cardiothoracic ratios toward a normal ECG and chest x-ray film pattern among hypertensive subjects. These findings are of particular importance because these indices are predictors of poor prognosis among untreated patients with hypertension.