Aggressive blood pressure lowering is safe, but benefit is still hard to prove
The Hypertension Optimal Treatment trial
Donald G. Vidt, MD
Senior physician, Department of Nephrology/Hypertension, Cleveland Clinic; professor of internal medicine, Ohio State University; member, Sixth Joint National Committee on Detection Evaluation, and Treatment of High Blood Pressure
Marc A. Pohl, MD
Department of Nephrology/Hypertension, Cleveland Clinic; investigator, Hypertension Optimal Treatment Trial*
Address: Donald G. Vidt, MD, Department of Nephrology/Hypertension, A101, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
*The Hypertension Optimal Treatment trial was sponsored by Astra AB, Sweden; Astra Merck Inc., USA; and Hoechst, Argentina.
In the Hypertension Optimal Treatment (HOT) study, hypertensive patients who were randomly assigned to undergo antihypertensive treatment to achieve a goal diastolic blood pressure of 80 mm Hg or lower did not experience fewer cardiovascular events than did patients who received treatment with goal pressures of 85 or 90 mm Hg. Such aggressive antihypertensive treatment was safe and well tolerated, and did result in fewer cardiovascular events in the subset of patients with diabetes. All patients were randomly assigned to take aspirin 75 mg/day or placebo, and patients in the aspirin group had a 15% lower rate of major cardiovascular events and myocardial infarctions than did patients who received placebo. This finding establishes the efficacy of aspirin in preventing strokes and myocardial infarctions in hypertensive patients.