Educational level and 5-year all-cause mortality in the Hypertension Detection and Follow-up Program. Hypertension Detection and Follow-up Program Cooperative Group

Abstract

Excess mortality in persons of lower socioeconomic status is a finding confirmed in many population studies. Among the nearly 11,000 hypertensive trial participants in the population-based Hypertension Detection and Follow-up Program, lower educational level (an indicator of low socioeconomic status) was associated with a 5-year death rate significantly above that found in those with higher education. This report examines whether this excess was observed uniformly within both treatment groups--stepped care and referred care--or whether the more vigorous antihypertensive program of stepped care was able to reduce the mortality gradient associated with education. In addition, impact on mortality of degree of blood pressure control during the trial was assessed within stepped and referred care groups, taking account also of educational level. Finally, the benefit of stepped care compared with referred care (control group) in reducing mortality was analyzed, controlling for education. Referred care participants with less than a high school education had a 5-year death rate twice as high as those with more than a high school education, whereas no such gradient of mortality was seen in the stepped care group. Level of blood pressure control throughout the trial was better in the stepped than in the referred care group and was significantly (inversely) associated with mortality in the stepped care group, regardless of educational level. In the referred care group as well, the better the control of elevated blood pressure (again, regardless of educational level), the lower the mortality, although this inverse association did not quite reach statistical significance in the referred care group.(ABSTRACT TRUNCATED AT 250 WORDS)