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Hypertension optimal treatment (HOT) study: home blood pressure in treated hypertensive subjects
S E Kjeldsen1, T Hedner, K Jamerson
1Division of Cardiology, Ullevaal University Hospital, Oslo, Norway. sverrekj@ulrik.uio.no
Insights
Office and home blood pressure (BP) measurements are comparable in treated hypertensive patients. Target BP groups defined by office readings were maintained at home in the Hypertension Optimal Treatment Study.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Trials
Background:
- The Hypertension Optimal Treatment (HOT) Study investigated blood pressure targets and aspirin use in hypertensive patients.
- A substudy aimed to compare office versus home blood pressure (BP) measurements.
Purpose of the Study:
- To compare home blood pressure (BP) with office BP in a subsample of HOT Study participants.
- To determine if target BP groups established by office readings were reflected in home BP measurements.
Main Methods:
- A substudy of 926 patients from the HOT Study was conducted in nine countries.
- Office and home BP were measured using the same semiautomatic device after treatment titration.
Main Results:
- No significant differences were found between office and home diastolic BP (0.2 mm Hg) or systolic BP (0.5 mm Hg).
- Significant differences in home BP were observed between target groups: diastolic BP varied by 1.9 mm Hg and 2.6 mm Hg for systolic BP between the < or = 80 and < or = 85 mm Hg groups.
Conclusions:
- Office and home BP measurements are comparable in treated hypertensive patients within the HOT Study.
- Blood pressure control achieved through office-based targets is sustained in out-of-office settings.
Abstract:
The Hypertension Optimal Treatment Study is a prospective trial conducted in 26 countries. The aims are to (1) evaluate the relationship between three levels of target office diastolic blood pressure (BP) (< or = 80, < or = 85, or < or = 90 mm Hg) and cardiovascular morbidity and mortality in hypertensive patients and (2) examine the effects on cardiovascular morbidity and mortality of 75 mg aspirin daily versus placebo. A total of 19,193 patients between 50 and 80 years of age had been randomized by the end of April 1994. Treatment was initiated with felodipine 5 mg daily, and additional therapy was given in accordance with a set protocol. The present substudy of 926 patients performed in nine countries aimed to (1) compare home with office BP in a representative subsample of the HOT population after the titration of treatment was completed and (2) clarify whether the separation into the target groups could be expanded into the out-of-office setting. The differences between office and home measurements in diastolic BP of 0.2 mm Hg (SD, 9; 95% confidence interval, -0.36 to 0.81; P=.40) and systolic BP of 0.5 mm Hg (SD, 15; 95% confidence interval, -0.53 to 1.46; P=.21) were not significant. The group differences in home BP were 1.9 mm Hg (< or = 80 versus < or = 85) and 1.2 mm Hg (< or = 85 versus < or = 90) for diastolic BP (F=11.69; ANOVA, P<.0001) and 2.6 and 2.1 mm Hg for systolic BP (F=8.44, P=.0002). Thus, office and home BPs measured with the same semiautomatic device are comparable in treated hypertensive subjects in the HOT Study, and the separation into the target groups based on office readings prevails at home.