Socioeconomic status in the epidemiology and treatment of hypertension.

The association of socioeconomic status (SES), as indexed by educational achievement, with the prevalence, prognosis, and efficacy of treatment of hypertension in the Hypertension Detection and Follow-up Program (HDFP) was reviewed. The prevalence of hypertension varied inversely with SES during the screening program initiated to identify HDFP eligibles in 14 communities in 1973-1974. There was a strong inverse gradient of 5-year all-cause mortality with SES among the hypertensive participants referred to usual care in the HDFP. The association of mortality with SES among hypertensive subjects was eliminated by the HDFP stepped-care program. A large portion of the efficacy of the HDFP was associated with in-trial blood pressure control. Inasmuch as these results are generalizable to the nation, a large fraction of hypertension-associated morbidity and mortality in the United States was related to lower SES in the 1970s, before widespread implementation of programs resulting in increased awareness, treatment, and control of hypertension.