Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: Principal results of the Hypertension Optimal Treatment (HOT) randomised trial

Lennart Hansson, Alberto Zanchetti, S. George Carruthers, Björn Dahlöf, Dag Elmfeldt, Stevo Julius, Joël Ménard, Karl Heinz Rahn, Hans Wedel, Sten Westerling

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Abstract

Background. Despite treatment, there is often a higher incidence of cardiovascular complications in patients with hypertension than in normotensive individuals. Inadequate reduction of their blood pressure is a likely cause, but the optimum target blood pressure is not known. The impact of acetylsalicylic acid (aspirin) has never been investigated in patients with hypertension. We aimed to assess the optimum target diastolic blood pressure and the potential benefit of a low dose of acetylsalicylic acid in the treatment of hypertension. Methods. 18,790 patients, from 26 countries, aged 50-80 years (mean 61.5 years) with hypertension and diastolic blood pressure between 100 mm Hg and 115 mm Hg (mean 105 mm Hg) were randomly assigned a target diastolic blood pressure. 6264 patients were allocated to the target pressure ≤ 90 mm Hg, 6264 to ≤ 85 mm Hg, and 6262 to ≤ 80 mm Hg. Felodipine was given as baseline therapy with the addition of other agents, according to a five-step regimen. In addition, 9399 patients were randomly assigned 75 mg/day acetylsalicylic acid (Bamycor, Astra) and 9391 patients were assigned placebo. Findings. Diastolic blood pressure was reduced by 20.3 mm Hg, 22.3 mm Hg, and 24.3 mm Hg, in the ≤ 90 mm Hg, ≤ 85 mm Hg, and ≤ 80 mm Hg target groups, respectively. The lowest incidence of major cardiovascular events occurred at a mean achieved diastolic blood pressure of 82.6 mm Hg; the lowest risk of cardiovascular mortality occurred at 86.5 mm Hg. Further reduction below these blood pressures was safe. In patients with diabetes mellitus there was a 51% reduction in major cardiovascular events in target group ≤ 80 mm Hg compared with target group ≤ 90 mm Hg (p for trend = 0.005). Acetylsalicylic acid reduced major cardiovascular events by 15% (p = 0.03) and all myocardial infarction by 36% (p = 0.002), with no effect on stroke. There were seven fatal bleeds in the acetylsalicylic acid group and eight in the placebo group, and 129 versus 70 non-fatal major bleeds in the two groups, respectively (p <0.001). Interpretation. Intensive lowering of blood pressure in patients with hypertension was associated with a low rate of cardiovascular events. The HOT Study shows the benefits of lowering the diastolic blood pressure down to 82.6 mm Hg. Acetylsalicylic acid significantly reduced major cardiovascular events with the greatest benefit seen in all myocardial infarction. There was no effect on the incidence of stroke or fatal bleeds, but non-fatal major bleeds were twice as common.

Original languageEnglish
Pages (from-to)1755-1762
Number of pages8
JournalLancet
Volume351
Issue number9118
DOIs
Publication statusPublished - Jun 13 1998

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Hypotension
Aspirin
Blood Pressure
Hypertension
Therapeutics
Incidence
Stroke
Myocardial Infarction
Placebos
Felodipine
Diabetes Mellitus

ASJC Scopus subject areas

  • Medicine(all)

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Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension : Principal results of the Hypertension Optimal Treatment (HOT) randomised trial. / Hansson, Lennart; Zanchetti, Alberto; Carruthers, S. George; Dahlöf, Björn; Elmfeldt, Dag; Julius, Stevo; Ménard, Joël; Rahn, Karl Heinz; Wedel, Hans; Westerling, Sten.

In: Lancet, Vol. 351, No. 9118, 13.06.1998, p. 1755-1762.

Research output: Contribution to journalArticle

Hansson, L, Zanchetti, A, Carruthers, SG, Dahlöf, B, Elmfeldt, D, Julius, S, Ménard, J, Rahn, KH, Wedel, H & Westerling, S 1998, 'Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: Principal results of the Hypertension Optimal Treatment (HOT) randomised trial', Lancet, vol. 351, no. 9118, pp. 1755-1762. https://doi.org/10.1016/S0140-6736(98)04311-6
Hansson, Lennart ; Zanchetti, Alberto ; Carruthers, S. George ; Dahlöf, Björn ; Elmfeldt, Dag ; Julius, Stevo ; Ménard, Joël ; Rahn, Karl Heinz ; Wedel, Hans ; Westerling, Sten. / Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension : Principal results of the Hypertension Optimal Treatment (HOT) randomised trial. In: Lancet. 1998 ; Vol. 351, No. 9118. pp. 1755-1762.
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abstract = "Background. Despite treatment, there is often a higher incidence of cardiovascular complications in patients with hypertension than in normotensive individuals. Inadequate reduction of their blood pressure is a likely cause, but the optimum target blood pressure is not known. The impact of acetylsalicylic acid (aspirin) has never been investigated in patients with hypertension. We aimed to assess the optimum target diastolic blood pressure and the potential benefit of a low dose of acetylsalicylic acid in the treatment of hypertension. Methods. 18,790 patients, from 26 countries, aged 50-80 years (mean 61.5 years) with hypertension and diastolic blood pressure between 100 mm Hg and 115 mm Hg (mean 105 mm Hg) were randomly assigned a target diastolic blood pressure. 6264 patients were allocated to the target pressure ≤ 90 mm Hg, 6264 to ≤ 85 mm Hg, and 6262 to ≤ 80 mm Hg. Felodipine was given as baseline therapy with the addition of other agents, according to a five-step regimen. In addition, 9399 patients were randomly assigned 75 mg/day acetylsalicylic acid (Bamycor, Astra) and 9391 patients were assigned placebo. Findings. Diastolic blood pressure was reduced by 20.3 mm Hg, 22.3 mm Hg, and 24.3 mm Hg, in the ≤ 90 mm Hg, ≤ 85 mm Hg, and ≤ 80 mm Hg target groups, respectively. The lowest incidence of major cardiovascular events occurred at a mean achieved diastolic blood pressure of 82.6 mm Hg; the lowest risk of cardiovascular mortality occurred at 86.5 mm Hg. Further reduction below these blood pressures was safe. In patients with diabetes mellitus there was a 51{\%} reduction in major cardiovascular events in target group ≤ 80 mm Hg compared with target group ≤ 90 mm Hg (p for trend = 0.005). Acetylsalicylic acid reduced major cardiovascular events by 15{\%} (p = 0.03) and all myocardial infarction by 36{\%} (p = 0.002), with no effect on stroke. There were seven fatal bleeds in the acetylsalicylic acid group and eight in the placebo group, and 129 versus 70 non-fatal major bleeds in the two groups, respectively (p <0.001). Interpretation. Intensive lowering of blood pressure in patients with hypertension was associated with a low rate of cardiovascular events. The HOT Study shows the benefits of lowering the diastolic blood pressure down to 82.6 mm Hg. Acetylsalicylic acid significantly reduced major cardiovascular events with the greatest benefit seen in all myocardial infarction. There was no effect on the incidence of stroke or fatal bleeds, but non-fatal major bleeds were twice as common.",
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T1 - Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension

T2 - Principal results of the Hypertension Optimal Treatment (HOT) randomised trial

AU - Hansson, Lennart

AU - Zanchetti, Alberto

AU - Carruthers, S. George

AU - Dahlöf, Björn

AU - Elmfeldt, Dag

AU - Julius, Stevo

AU - Ménard, Joël

AU - Rahn, Karl Heinz

AU - Wedel, Hans

AU - Westerling, Sten

PY - 1998/6/13

Y1 - 1998/6/13

N2 - Background. Despite treatment, there is often a higher incidence of cardiovascular complications in patients with hypertension than in normotensive individuals. Inadequate reduction of their blood pressure is a likely cause, but the optimum target blood pressure is not known. The impact of acetylsalicylic acid (aspirin) has never been investigated in patients with hypertension. We aimed to assess the optimum target diastolic blood pressure and the potential benefit of a low dose of acetylsalicylic acid in the treatment of hypertension. Methods. 18,790 patients, from 26 countries, aged 50-80 years (mean 61.5 years) with hypertension and diastolic blood pressure between 100 mm Hg and 115 mm Hg (mean 105 mm Hg) were randomly assigned a target diastolic blood pressure. 6264 patients were allocated to the target pressure ≤ 90 mm Hg, 6264 to ≤ 85 mm Hg, and 6262 to ≤ 80 mm Hg. Felodipine was given as baseline therapy with the addition of other agents, according to a five-step regimen. In addition, 9399 patients were randomly assigned 75 mg/day acetylsalicylic acid (Bamycor, Astra) and 9391 patients were assigned placebo. Findings. Diastolic blood pressure was reduced by 20.3 mm Hg, 22.3 mm Hg, and 24.3 mm Hg, in the ≤ 90 mm Hg, ≤ 85 mm Hg, and ≤ 80 mm Hg target groups, respectively. The lowest incidence of major cardiovascular events occurred at a mean achieved diastolic blood pressure of 82.6 mm Hg; the lowest risk of cardiovascular mortality occurred at 86.5 mm Hg. Further reduction below these blood pressures was safe. In patients with diabetes mellitus there was a 51% reduction in major cardiovascular events in target group ≤ 80 mm Hg compared with target group ≤ 90 mm Hg (p for trend = 0.005). Acetylsalicylic acid reduced major cardiovascular events by 15% (p = 0.03) and all myocardial infarction by 36% (p = 0.002), with no effect on stroke. There were seven fatal bleeds in the acetylsalicylic acid group and eight in the placebo group, and 129 versus 70 non-fatal major bleeds in the two groups, respectively (p <0.001). Interpretation. Intensive lowering of blood pressure in patients with hypertension was associated with a low rate of cardiovascular events. The HOT Study shows the benefits of lowering the diastolic blood pressure down to 82.6 mm Hg. Acetylsalicylic acid significantly reduced major cardiovascular events with the greatest benefit seen in all myocardial infarction. There was no effect on the incidence of stroke or fatal bleeds, but non-fatal major bleeds were twice as common.

AB - Background. Despite treatment, there is often a higher incidence of cardiovascular complications in patients with hypertension than in normotensive individuals. Inadequate reduction of their blood pressure is a likely cause, but the optimum target blood pressure is not known. The impact of acetylsalicylic acid (aspirin) has never been investigated in patients with hypertension. We aimed to assess the optimum target diastolic blood pressure and the potential benefit of a low dose of acetylsalicylic acid in the treatment of hypertension. Methods. 18,790 patients, from 26 countries, aged 50-80 years (mean 61.5 years) with hypertension and diastolic blood pressure between 100 mm Hg and 115 mm Hg (mean 105 mm Hg) were randomly assigned a target diastolic blood pressure. 6264 patients were allocated to the target pressure ≤ 90 mm Hg, 6264 to ≤ 85 mm Hg, and 6262 to ≤ 80 mm Hg. Felodipine was given as baseline therapy with the addition of other agents, according to a five-step regimen. In addition, 9399 patients were randomly assigned 75 mg/day acetylsalicylic acid (Bamycor, Astra) and 9391 patients were assigned placebo. Findings. Diastolic blood pressure was reduced by 20.3 mm Hg, 22.3 mm Hg, and 24.3 mm Hg, in the ≤ 90 mm Hg, ≤ 85 mm Hg, and ≤ 80 mm Hg target groups, respectively. The lowest incidence of major cardiovascular events occurred at a mean achieved diastolic blood pressure of 82.6 mm Hg; the lowest risk of cardiovascular mortality occurred at 86.5 mm Hg. Further reduction below these blood pressures was safe. In patients with diabetes mellitus there was a 51% reduction in major cardiovascular events in target group ≤ 80 mm Hg compared with target group ≤ 90 mm Hg (p for trend = 0.005). Acetylsalicylic acid reduced major cardiovascular events by 15% (p = 0.03) and all myocardial infarction by 36% (p = 0.002), with no effect on stroke. There were seven fatal bleeds in the acetylsalicylic acid group and eight in the placebo group, and 129 versus 70 non-fatal major bleeds in the two groups, respectively (p <0.001). Interpretation. Intensive lowering of blood pressure in patients with hypertension was associated with a low rate of cardiovascular events. The HOT Study shows the benefits of lowering the diastolic blood pressure down to 82.6 mm Hg. Acetylsalicylic acid significantly reduced major cardiovascular events with the greatest benefit seen in all myocardial infarction. There was no effect on the incidence of stroke or fatal bleeds, but non-fatal major bleeds were twice as common.

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