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Risk assessment and treatment benefit in intensively treated hypertensive patients of the hypertension Optimal

A Zanchetti1, L Hansson, J Ménard

  • 1Centro di Fisiologia Clinica e Ipertensione, Università di Milano, Ospedale Maggiore and Istituto Auxologico Italiano, Italy. zanchett@mailserver.unimi.it

Journal of Hypertension
|May 2, 2001
PubMed

Insights

The Hypertension Optimal Treatment (HOT) Study found that intensive blood pressure lowering significantly reduced cardiovascular events in hypertensive patients. Risk stratification confirmed that even with excellent control, pre-treatment risk remained a key factor in event incidence.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Clinical Trials

Background:

  • The Hypertension Optimal Treatment (HOT) Study involved 18,790 hypertensive patients.
  • Patients underwent pronounced blood pressure lowering over a mean of 3.8 years.

Purpose of the Study:

  • To analyze cardiovascular event rates in hypertensive patients after risk stratification.
  • To assess the impact of intensive blood pressure lowering on cardiovascular events across different risk strata.

Main Methods:

  • Patients were stratified into risk categories using 1999 WHO and ISH guidelines.
  • Cardiovascular event incidence was analyzed in relation to pre-treatment risk and blood pressure control (DBP < or = 90 mmHg in 92% of patients).

Main Results:

  • No patients were low risk; 50% were medium, 20.2% high, and 29.8% very high risk.
  • Cardiovascular event incidence was proportional to pre-treatment risk, even with excellent blood pressure control.
  • Event rates were significantly lower (estimated 60% reduction) than expected based on Framingham equation risk.

Conclusions:

  • Intensive blood pressure lowering is likely responsible for the low event rate observed in the HOT Study.
  • A persistent risk gradient suggests combining blood pressure control with other risk reduction strategies.
  • Initiating antihypertensive therapy before complications develop is crucial.
Abstract

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