The Tiwi PPPP is a double blind randomised, placebo controlled trial, seeking to determine whether medical treatment can delay or prevent the onset of hypertension, kidney disease and diabetes in Aboriginal adults.

Pharmacologic prevention potentially offers the quickest and most efficient response for people whose high-risk status is already established. The justification is avoidance or delay of the 80% certainty by middle age of developing the target symptom complex. This should mean fewer complications such as stroke, heart attack, blindness and kidney failure and their attendant disability and hospitalisations, and reductions in premature natural death, nearly all of which are predicted by albuminuria, hypertension and diabetes.

Potential participants will benefit through having their health status reexamined during eligibility assessment. Those with established problems will benefit from earlier diagnosis and potentially, appropriate treatment. They might also become candidates for trials of modalities to improve secondary prevention (treatment of established disease). If primary prevention proves effective, participants in the active arm of the trial would have the clinical benefits outlined above, as would everyone else if the treatment was thereafter incorporated into routine practice. 

Development of the epidemic of chronic disease in remote-living Aborigines has been especially dramatic due to the compressed and brutal nature of their societal transition, and simultaneous transformation of their health services. Their accentuated disease susceptibility, however, is shared by many other populations in epidemiologic and health transition, and the perspectives gained from this trial should be applicable to other high risk groups. If primary pharmacologic intervention proves successful in the Aboriginal population, it can then be applied more selectively to appropriate target groups in other populations. Its application in the Aboriginal population, too, might ultimately become more selective, if other factors ultimately reduce or alter the balance of risk factors.