Hypertension Optimal Treatment-HOT Study

Type-2 diabetes mellitus is known to increase dramatically the risk of cardiovascular death, as shown, among several other studies, in the large cohort of 340,000 men screened in the Multiple Risk Factor Intervention Trial 11], Useful information has also been provided by the Hypertension Optimal Treatment (HOT) study [2], with analyses comparing cardiovascular outcomes in 1,503 diabetic hypertensives and 17,230 non-diabetic hypertensives, all subjected to intense antihypertensive treatment incidences of myocardial infarction, stroke, all major cardiovascular events, cardiovascular and all-cause mortalities were much higher in diabetics than in non-diabetics with relative risk of 1.45-2.13 even after adjusting for all other baseline risk factors (Fig. 1). Calculations from a recent meta-analysis of antihypertensive treatment trials... 

Fig. 1. Incidence of various types of cardiovascular (CV) events in diabetic (DM) and non-diabetic (no DM) patients within the intensely treated cohort of the Hypertension Optimal Treatment (HOT) Study. Event incidence per 1000 patient years (pt yrs). On top of the histograms adjusted relative risk (Adj. RR) and 95% confidence intervals (Cl) of diabetics vs non-diabetics. MLmyocardial infarction. (Redrawn from ref. 2).

Acute renal failure developed in a woman taking captopril when she started to take aspirin for arthritis. Renal function improved when both were stopped. However, in a re-analysis of data from the Hypertension Optimal Treatment (HOT) study, long-term low-dose aspirin 75 mg daily had no effect on changes in serum creatinine, estimated creatinine clearance or the number of patients developing renal impairment, when compared with placebo. Of 18 790 treated hypertensive patients, 41% receiv an ACE inhibitor. ... 

Felodipine. In the Hypertension Optimal Treatment (HOT) study, 18 790 treated hypertensive patients, about 82% of whom received a calcium-channel blocker, usually felodipine alone or in combination, were also given either aspirin 75 mg daily or placebo for an average of 3.8 years. It was found that long-term low-dose aspirin does not interfere with the blood pressure-lowering effects of the antihypertensive drugs studied. ... 

Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Ehn-feldt D, Julius S et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998 351(9118) 1755-62. 

Lower-goal BP values have been evaluated prospectively in the Hypertension Optimal Treatment (HOT) trial. In this study, over 18,700 patients were randomized to target DBP values of 90, 85, or 80 mm Hg or less. Although the actual DBP values achieved were 85.2, 83.2, and 81.1 mm Hg, respectively, the risk of major cardiovascular events was the lowest with a BP of 139/83 mm Hg, and lowest risk of stroke was with a BP of 142/80 mm Hg. Risk of events in subjects with either diabetes or ischemic heart disease was lowest at DBP values of less than 80 mm Hg. No J-curve relationship was seen. The HOT trial results provide evidence that support the JNC recommended goal value of less than 140/90 mm Hg for most patients and the more aggressive goal of less than 130/80 mm Hg in patients with diabetes. 

Principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998 351 1755-1762. 

Fig. 3. Hazard ratios of aspirin versus placebo for all cardiovascular (CV) events, all coronary (CHD) events, and all strokes in diabetic patients included in four randomized trials. ETDRS Early Treatment Diabetic Retinopathy Study PHS Physicians Health Study HOT Hypertension Optimal Treatment Study WHS Women s Health Study. References are indicated by numbers accompanying the acronyms.

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