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Lowering Blood Pressure Below Traditional Target Reduces Cardiovascular Risk AMSTERDAM, THE NETHERLANDS -- June 10, 1998 -- Lowering diastolic blood pressure beyond the currently recommended level of 90 mmHg can help reduce the risk of major cardiovascular events, according to the Hypertension Optimal Treatment (HOT) study, the largest hypertension outcomes trial ever completed. Researchers, who unveiled HOT study results today at the annual meeting of the International Society of Hypertension, also found that among the patients with diabetes, the risk of sustaining a major cardiovascular event was more than double in patients randomised to diastolic blood pressure of 90 mmHg versus those targeted to 80 mmHg; and the number of cardiovascular disease-related deaths was much higher in the patients targeted to 90 mmHg versus 80 mmHg. Both findings were highly statistically significant. The HOT Study was conducted using baseline therapy of Astra Merck’s calcium channel blocker Plendil (felodipine) and, as needed, the addition of one or more other hypertension medications to lower diastolic blood pressure to one of three target blood pressure levels. The study amassed more than 71,000 patient years of data from 18,790 patients in 26 countries over a five-year period. "What we've learned is that lowering blood pressure just to the point where it isn't high isn't enough," said Claude Lenfant, MD, director of the National Heart, Lung and Blood Institute. "The HOT study supports the goal of hypertensive therapy as outlined in the JNC VI. If physicians lower blood pressure beyond traditional levels of 90 mmHg, there's reason to believe that cardiovascular morbidity and mortality can be diminished." In the HOT Study, patients were randomised to three target blood pressures -- 90, 85 or 80 mmHg and then followed to see how many strokes, heart attacks or related deaths occurred in each group. At the conclusion of the HOT Study, a total of 724 cardiovascular events had been analysed. During the course of the study, only 2.6 percent of patients were lost to follow-up. The benefit of aiming for a lower diastolic blood pressure target can be seen in the incidence of heart attack associated with the three different target blood pressures. In the patients randomised to 90 mmHg there were 84 cases, while the reduction was more pronounced in the other two groups. There were 64 heart attacks in the 85 mmHg group and 61 in the 80 mmHg group. "The HOT study is an unprecedented effort to help physicians decide how low they should go when it comes to treating high blood pressure," said Kenneth Jamerson, MD, associate professor of medicine, University of Michigan Medical Center's division of hypertension and HOT investigator. "Many physicians believe it's unrealistic to try to achieve a diastolic blood pressure score of 80. We found by using appropriate hypertension medications, blood pressure could be lowered to this number in the majority of patients." The HOT study also confirmed that the addition of low-dose aspirin to antihypertensive therapy is beneficial in reducing the risk of cardiovascular morbidity and mortality in patients with well-controlled hypertension. The incidence of heart attacks was reduced by 36 percent in patients randomised to additionally take a low dose of aspirin (75 mg daily) each day versus placebo. The overall incidence of a major cardiovascular event was reduced in the aspirin-treated patients by 15 percent. Results also indicate that the association of aspirin with antihypertensive therapy can be recommended, provided that blood pressure is well controlled and the risk of gastrointestinal and nasal bleeding is carefully evaluated. Combination therapy was found to be the most effective method of aggressively reaching the target diastolic blood pressure. Patients could receive up to three different drugs to reach their target blood pressure. A majority of patients required combination therapy to reach the most aggressive target of 8O mmHg. In patients with coronary artery disease, there was a 43 percent reduction in strokes for patients in the target blood pressure group of 80 mmHg. High blood pressure -- or hypertension -- is the most common cardiovascular disorder and a leading cause of death in the United States. Approximately 250,000 deaths per year in persons aged 65 to 84 years are due to cardiovascular disease and more than $259 billion US dollars in direct and indirect costs are spent in the U.S. alone for hospitalisations and the treatment of hypertension-related complications such as stroke, heart failure and end-stage renal disease. All patients enrolled in the study received felodipine and other blood pressure medications as needed to reach their randomly assigned target blood pressure. Felodipine was selected as baseline therapy because it has few contraindications, is efficacious, has few drug interactions, is generally well-tolerated and is taken once daily. The medications used in the HOT Study were well tolerated. The reported side effects that exceeded two percent were dizziness, headache, leg edema, flushing and cough. E-mail this page to a friend or colleague! To print, use this version