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The hypertension optimal treatment study: What did it give us?

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Abstract

The Hypertension Optimal Treatment study was a large, randomized, multicenter study to determine the answers to two questions: 1) what is the optimal target blood pressure to be sought in the treatment of patients with moderate hypertension? and 2) does low dose aspirin therapy decrease morbidity and mortality in patients with hypertension? After 3.8 years of follow-up for the almost 19,000 patients, the following conclusions from the study could be ascertained 1) lowering diastolic blood pressure in patients with diabetes to levels below 80 mm Hg decreases the risk of major cardiovascular events and cardiovascular mortality compared with lowering it to "normal" (< 90 mm Hg) levels It may lower total mortality, but this study was not powered for this end point; 2) aspirin therapy, in patients with hypertension, is safe and decreases major cardiovascular events and acute myocardial infarction; 3) there does not appear to be an additional effect on cardiovascular mortality or overall mortality below that observed with a reduction of diastolic blood pressure to less than 90 mm Hg for the population as a whole; and 4) the lowest cardiovascular event rate for the population as a whole was achieved at a diastolic blood pressure of 83 mm Hg. Several limitations to this study exist, including the low event rate achieved and the generalizability of this study to the average nondiabetic patient with hypertension seen in clinical practice

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References and Recommended Reading

  1. Hansson L, Zanchetti A, Carruthers SG, et al.: Effects o intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet 1998, 351:1755–1762. This is the main report of the results of the HOT study. It includes the final report of the study with analysis of the primary endpoints as well as the other preplanned statistical analyses.

    Article  PubMed  CAS  Google Scholar 

  2. Hansson L, Zanchetti A: The Hypertension Optimal Treatment (HOT) Study: 12-month data on blood pressure and tolerability with special reference to age and gender Blood Press 1995, 4:313–319.

    PubMed  CAS  Google Scholar 

  3. Hansson L, Zanchetti A: The Hypertension Optimal Treatment (HOT) study: patient characteristics: randomization, risk profile and early blood pressure results. Blood Press 1994, 3:322–327.

    PubMed  CAS  Google Scholar 

  4. Hansson L: The Hypertension Optimal Treatment Study (The HOT Study). Blood Press 1993, 2:62–68.

    Google Scholar 

  5. Wiklund I, Halling K, Ryden-Bergsten T, et al.: Does lowering the blood pressure improve the mood? Quality-of-life results from the Hypertension Optimal Treatment (HOT) study. Blood Press 1997, 6:357–364.

    PubMed  CAS  Google Scholar 

  6. Hansson L, Zanchetti A: The Hypertension Optimal Treatment (HOT) study: 24 month data on blood pressure and tolerability. Blood Press 1997, 6:313–317. This is intermediate data on the HOT study. It demonstrates how well the treatment was tolerated and how aggressively the blood pressure was maintained.

    PubMed  CAS  Google Scholar 

  7. Julius S: The Hypertension Optimal Treatment (HOT) Study in the United States. Am J Hypertens 1996, 9:41S-44S.

    Article  PubMed  CAS  Google Scholar 

  8. Chalmers J: The HOT Study: design and cost of major blood pressure trials. Blood Press 1994, 3:276–278.

    PubMed  CAS  Google Scholar 

  9. SHEP Cooperative Research Group: Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension—Final results of the Systolic Hyperten sion in the Elderly Program. JAMA 1991, 265:3255–3264

    Article  Google Scholar 

  10. Graettinger WF, Weber MA: The Hypertension Syndrome: more than increased blood pressure. Modern Medicine 1992, 60:118–126.

    Google Scholar 

  11. Cruickshank JM, Thorp JM, Zacharias FJ: Benefits and potential harm of lowering high blood pressure. Lancet 1987, i:581–584.

    Article  Google Scholar 

  12. Alderman MH, Ooi WL, Madhavan S, et al.: Treatment induced blood pressure reduction and the risk of myocardial infarction. JAMA 1989, 262:920–924.

    Article  PubMed  CAS  Google Scholar 

  13. Mancia G, Sega R, Milesi C, et al.: Blood pressure control in the hypertensive population. Lancet 1997, 349:454–457.

    Article  PubMed  CAS  Google Scholar 

  14. Dahlof B, Lindholm LH, Hansson L, et al.: Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 1991, 338:1281–1285.

    Article  PubMed  CAS  Google Scholar 

  15. Hansson L: How far should blood pressure be lowered? What is the Role of the J-curve? Am J Hypertens 1990, 3:726–729.

    PubMed  CAS  Google Scholar 

  16. Hansson L: The benefits of lowering elevated blood pressure: a critical review of studies of cardiovascular morbidity and mortality in hypertension. J Hypertens 1996, 14:537–544.

    Article  PubMed  CAS  Google Scholar 

  17. Steering committee of the Physicians Health Study Research Group: Final report on the aspirin component of the ongoing Physicians Health Study. N Engl J Med 1989, 321:129–135.

    Article  Google Scholar 

  18. Juul-Moller S, Edvardsson N, Jahnmatz B, et al.: Double-blind trial of aspirin in primary prevention of myocardial infarction in patients with stable chronic angina pectoris. Lancet 1992, 340:1421–1425.

    Article  PubMed  CAS  Google Scholar 

  19. The SALT collaborative group: Swedish Aspirin Low-dose Trial (SALT) of 75 mg aspirin as secondary prophylaxis after cerebrovascular ischaemic events. Lancet 1991, 338:1345–1349.

    Article  Google Scholar 

  20. Hansson L, Hedner T, Dahlof B: Prospective, randomized, open blinded end-point (PROBE) study. A novel design for intervention trials. Blood Press 1992, 1:113–119.

    PubMed  CAS  Google Scholar 

  21. Bryg RJ, Johns JP, Bryg DJ: Cardiac and noncardiac mortality in reported studies: how they compare to the population. Can J Cardiol 1997, 13:63B.

    Google Scholar 

  22. Bryg RJ, Johns JP, Bryg DJ: Cardiovascular mortality in clinical trials: implications for decision analysis. Med Decis Making 1997, 17:539.

    Google Scholar 

  23. Bryg DJ, Bryg RJ: Life Effectiveness analysis: technique for trading clinical life years for societal life-years. Am J Manag Care 1995, 1:237–244.

    Google Scholar 

  24. Shepherd J, Cobbe SM, Ford I, et al.: Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995, 333:1301–1307.

    Article  PubMed  CAS  Google Scholar 

  25. Scandinavian Simvastatin Survival Study Group: Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994, 344:1383–1389.

    Article  Google Scholar 

  26. Sacks FM, Pfeffer MA, Moye LA, et al.: The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels N Engl J Med 1996, 335:1001–1009.

    Article  PubMed  CAS  Google Scholar 

  27. Kendall MJ, Toescu V: The HOT Study. J Clin Pharm and Ther 1998, 23:137–139. This is one of the four editorials that address the J-curve. It is interesting the widespread disagreement between these authors as to the conclusions that can be drawn from the HOT study

    Article  CAS  Google Scholar 

  28. Chalmers J: Hypertension Optimal Treatment (HOT) study: a brilliant concept, but a qualified success. J Hypertens 1998, 16:1403–1405. This is one of the four editorials that address the J-curve. It is interesting the widespread disagreement between these authors as to the conclusions that can be drawn from the HOT study

    Article  PubMed  CAS  Google Scholar 

  29. Kaplan N: J-curve not burned off by HOT study. Lancet 1998, 351:1748–1749. This is one of the four editorials that address the J-curve. It is interesting the widespread disagreement between these authors as to the conclusions that can be drawn from the HOT study

    Article  PubMed  CAS  Google Scholar 

  30. Ibsen H: Intensive blood pressure lowering warranted: results of the HOT study: an epitaph for the J-curve concept in hypertension. J Hum Hypertens 1998, 12:731–732. This is one of the four editorials that address the J-curve. It is interesting the widespread disagreement between these authors as to the conclusions that can be drawn from the HOT study

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, University of Nevada School of Medicine, and Ioannis A. Lougaris VA Medical Center (111), 1000 Locust Street, 89520, Reno, NV, USA

    Robert J. Bryg MD & William F. Graettinger MD

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  1. Robert J. Bryg MD
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  2. William F. Graettinger MD
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Bryg, R.J., Graettinger, W.F. The hypertension optimal treatment study: What did it give us?. Current Science Inc 1, 337–341 (1999). https://doi.org/10.1007/s11906-999-0043-4

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  • DOI: https://doi.org/10.1007/s11906-999-0043-4

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