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Twenty-four hour ambulatory blood pressure in the Hypertension Optimal Treatment (HOT) study
1Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università di Milano-Bicocca, Ospedale San Gerardo, Monza, Italy. giuseppe.mancia@unimib.it
Insights
The Hypertension Optimal Treatment (HOT) study found that reducing diastolic blood pressure below 90 mmHg lowers cardiovascular events. Ambulatory blood pressure monitoring confirmed treatment effectiveness outside the clinic.
Area of Science:
- Cardiology
- Hypertension Management
- Clinical Trials
Background:
- The Hypertension Optimal Treatment (HOT) study demonstrated cardiovascular event reduction with lower diastolic blood pressure targets.
- Office blood pressure measurements do not reflect out-of-office readings.
- This HOT substudy integrated 24-hour ambulatory blood pressure monitoring (ABPM).
Purpose of the Study:
- To assess the impact of antihypertensive treatment on both office and ambulatory blood pressure.
- To evaluate the relationship between treatment intensity and blood pressure reduction using ABPM.
- To analyze trough-to-peak ratios and smoothness indices of antihypertensive therapy.
Main Methods:
- A substudy of the HOT trial involving 62-year-old patients treated for a median of 2 years.
- Patients received felodipine, with optional ACE-inhibitors, beta-blockers, or diuretics.
- Office and 24-hour ABPM were recorded at baseline and during treatment across different diastolic blood pressure targets (
Main Results:
- Baseline 24-hour ABPM (146/90 mmHg) was significantly lower than office BP (170/105 mmHg).
- Treatment reduced both office and ambulatory blood pressures, with a greater reduction observed in office BP.
- Between-group differences in blood pressure reduction were smaller for ambulatory BP compared to office BP.
Conclusions:
- Antihypertensive treatment in the HOT study effectively lowered both office and 24-hour ambulatory blood pressure.
- The reduction in ambulatory blood pressure was less pronounced than in office blood pressure.
- ABPM provides crucial data on treatment efficacy beyond clinic measurements.
Background And Aims:
The Hypertension Optimal Treatment (HOT) study showed that when antihypertensive treatment reduces diastolic blood pressure well below 90 mmHg, there can be a further reduction of cardiovascular events, particularly myocardial infarction, with no evidence of a J-shaped curve at lower pressures. Office measurement, however, gives no information about blood pressure outside the office. This paper describes a HOT substudy in which patients underwent both office measurement and 24 h ambulatory blood pressure monitoring.
Methods:
The mean age of the substudy population was 62 +/- 7 years. Substudy patients were treated for a median period of 2 years. All received the dihydropyridine calcium antagonist felodipine, while some also received an ACE-inhibitor, a beta-blocker or a diuretic. Average 24 h, day and night ambulatory blood pressure values were computed at baseline (n = 277) and during treatment (n = 347): 112 patients had been randomized to a target office diastolic blood pressure
Results:
Taking the subgroup as a whole, baseline 24 h average blood pressures (146 +/- 18/90 +/- 10 mmHg) were significantly and markedly lower than office blood pressures (170 +/- 14/105 +/- 3 mmHg, P < 0.01). Office, 24 h, day and night blood pressures were all significantly reduced by treatment, but there was a smaller fall in ambulatory, than in office pressures. The between group differences in office blood pressure were smaller than those observed in the overall HOT sample. Between-group differences in 24 h blood pressure were even smaller. Trough-to-peak ratios and smoothness indices were lowest in the highest blood pressure target group and highest in the lowest blood pressure target group. Office and ambulatory blood pressures were similar in the groups randomized to placebo (n = 170) or acetylsalicylic acid (n = 177).
Conclusion:
In conclusion, in the HOT study, treatment reduced not only office but also ambulatory blood pressure throughout the 24 h. The reduction was less marked for ambulatory than for office blood pressure.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure: