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[Short and long-term clinical tolerance of hypertensive treatment during the HOT study (Hypertension Optimal
J M Mallion1, N G Pehrsson, C Raveau-Landon
1Service de médecine interne et cardiologie, centre hospitalier universitaire de Grenoble.
Insights
This study found that while treatment intensity and patient factors influence side effect frequency, the optimal blood pressure (BP) target for reducing cardiovascular risk did not significantly impact clinical tolerance. Factors like geographic region and number of drugs prescribed were more influential.
Area of Science:
- Cardiology
- Clinical Pharmacology
- Hypertension Research
Background:
- Cardiovascular morbidity and mortality remain significant health concerns.
- Optimizing blood pressure (BP) control is crucial for reducing cardiovascular events.
- Identifying optimal treatment targets and understanding factors influencing treatment tolerance are essential.
Purpose of the Study:
- To determine the optimal blood pressure (BP) level for reducing cardiovascular morbidity and mortality.
- To investigate the influence of various factors on the clinical tolerance of antihypertensive treatment.
Main Methods:
- A large-scale, international, prospective, randomized controlled trial (HOT study) involving 19,193 patients.
- Patients were randomized to achieve diastolic blood pressure (DBP) targets of ≤80, ≤85, or ≤90 mmHg.
- Treatment involved escalating doses of felodipine, with bitherapy and tritherapy used as necessary.
Main Results:
- Clinical tolerance was not significantly influenced by the target BP or patient age.
- Side effects were more frequent at the start of treatment compared to the long term.
- Side effects were more common in Southern Europe than Northern Europe, and more frequent in women than men.
- The incidence of side effects was proportional to the number of antihypertensive drugs prescribed.
Conclusions:
- Treatment intensity and patient demographics had minimal impact on clinical tolerance.
- Geographic location, sex, and the number of antihypertensive medications are significant factors influencing treatment side effects.
- Time and the complexity of the antihypertensive regimen are key determinants of clinical tolerance.
Abstract:
International, prospective, randomized HOT study aims to determine the optimal BP level under treatment in order to reduce at the most the cardiovascular morbidity/mortality. Defined by randomization, the level to obtain is DBP < or = 80, 85, 90 mmHg. The treatment is started by felodipine 5 mg/day then, if necessary, a bitherapy is prescribed and then, if necessary, a tritherapy. 19,193 patients have been included (BP at randomization 170 +/- 15/105 +/- 4 mmHg). After 1 year treatment, it is possible to search for the influence on the clinical tolerance of sex, age, BP goal, geographic area, time and treatment. The percentage of patients with side effects by BP goals and by treatment type are, during the time and in different geographic areas, the following (NE/Northern Europe = Norway, Switzerland, Belgium, Hungary, Sweden, Denmark, Finland, The Netherlands, UK, Germany, Austria; SE/Southern Europe = Italy, Spain, Greece): [table: see text] The target BP and age don't nearly influence the clinical tolerance. The side effects reported by the physicians are more numerous at the treatment start than at longeur terme. That is due to the therapeutic modifications of the physicians or to a better acceptation of the drugs by the patients or to a real disappearance of the side effects. Reported side effects are more frequent in Southern Europe, France than Northern Europe and more frequent among women that men. The incidence of side effects is proportional to the number of prescribed drugs. Time and the number of antihypertensive drugs appear as the most important factors.