from the Hypertension Detection and Follow-up

gram (HDFP) showed a significant reduction in both cardiovascular and noncardiovascular death rates in patients receiving stepped care. Over the past three years, several reports ' 2 have suggested that the results of treatment reported in the HDFP were due to compre-hensive medical care of hypertensive patients in a stepped care treatment group rather than to a specific hypotensive effect of drug therapy. Also, the clinical significance of the 19 % reduction in cardiovascular mortality in patients under stepped care in comparison with those receiving referred care is questionable, be-cause noncardiovascular mortality was reduced by 14 % in the former group. In any hypertension intervention study in which the group on active therapy is seen more frequently than the control group, it is legitimate to ask whether the final benefits result from specific antihypertensive medication and effective blood pressure control or from general contact and comprehensive health care. Because of the implications for management of hyper-tensive patients it is deemed necessary to advance ex-planations for reduced noncardiovascular mortality among those that are successfully treated. A decrease in cardiovascular mortality might be expected to be responsible for an increase in mortality from cancer and other important causes of death over a long follow-up time because of competing risk. Therefore, if any-thing, the noncardiovascular mortality might have been expected to rise rather than fall in response to a decrease of cardiovascular mortality. Evidence for effective control of "mild " hypertension in lowering noncardiovascular death rate. The number o