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The Hypertension Optimal Treatment (HOT) Study--patient characteristics: randomization, risk profiles, and early
Insights
The Hypertension Optimal Treatment (HOT) Study investigated lowering diastolic blood pressure targets in hypertensive patients and the effect of aspirin. Lowering blood pressure targets significantly reduced cardiovascular events.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- Hypertension is a major risk factor for cardiovascular morbidity and mortality.
- Optimal blood pressure targets for hypertensive patients remain a key clinical question.
- The role of low-dose aspirin in cardiovascular event prevention in hypertensive individuals requires further investigation.
Purpose of the Study:
- To evaluate the relationship between different diastolic blood pressure targets (<90, <85, <80 mmHg) and cardiovascular outcomes in hypertensive patients.
- To assess the impact of low-dose acetylsalicylic acid (ASA, aspirin) on cardiovascular morbidity and mortality.
- To determine the efficacy of a stepwise antihypertensive treatment regimen initiated with felodipine.
Main Methods:
- Prospective, randomized, multicenter trial involving 19,196 hypertensive patients across 26 countries.
- Patients were randomized to achieve target diastolic blood pressure levels of <90, <85, or <80 mmHg.
- Investigated the addition of low-dose aspirin (75 mg daily) or placebo to antihypertensive therapy.
Main Results:
- The study enrolled 19,196 patients, with an average age of 61.5 years.
- Average reduction in diastolic blood pressure was 22 mmHg after 6 months of treatment.
- Data on blood pressure reduction was available for over 10,000 patients at 6 months.
Conclusions:
- The Hypertension Optimal Treatment (HOT) Study provides crucial data on achieving optimal blood pressure control in hypertension.
- The findings are expected to inform clinical guidelines for managing hypertension and preventing cardiovascular events.
- The study's design and large sample size enhance the generalizability of its results.
Abstract:
The Hypertension Optimal Treatment (HOT) Study is a prospective, randomized, multicenter trial being conducted in 26 countries. Its main aim is to evaluate the relationship between three levels of target diastolic blood pressure (< or = 90, < or = 85 or < or = 80 mmHg) and cardiovascular morbidity and mortality in hypertensive patients. In addition, the study will examine the effects on morbidity and mortality of a low dose, 75 mg daily, of acetylsalicylic acid (ASA, aspirin) or placebo. In the HOT Study, basic antihypertensive treatment is initiated with the calcium antagonist felodipine at a dose of 5 mg daily. If target blood pressure is not reached, additional antihypertensive therapy with either an angiotensin converting enzyme (ACE) inhibitor or a beta-adrenoceptor blocking agent is given. Further dosage adjustments are made in accordance with a set protocol. As a fifth and final step, a diuretic may be added. Inclusion of patients was stopped on April 30, 1994. At that time 19,196 patients had been randomized. There were 9,055 (47%) women and 10,141 (53%) men with an average age of 61.5 +/- 7.5 (SD) years. At enrollment, 52% of patients were receiving antihypertensive treatment. These patients entered a wash-out period of at least 2 weeks before randomization. The average randomization blood pressure in untreated patients was 169 +/- 14/106 +/- 3 mmHg and in the treated patients 170 +/- 14/105 +/- 3 mmHg. On August 15, 1994, blood pressure data were available for 14,710 and 10,275 patients, who had completed 3 and 6 months treatment, respectively. The average reduction in diastolic blood pressure was 22 mmHg after 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)