Description

The Hypertension Optimal Treatment (HOT) study is a prospective, open with blinded endpoints trial of hypertension treatment which assessed:

1. The relationship between major cardiovascular events and target diastolic blood pressure (DBP).
2. The relationship between major cardiovascular events and achieved DBP.
3. The role of aspirin for the primary prevention of cardiovascular events in patients with hypertension.

Patients were randomised to one of three target DBP groups (≤80, ≤85 and ≤90 mmHg) and randomised again to receive either aspirin or placebo. Baseline treatment with felodipine was commenced followed, if necessary, by additional therapy to achieve target diastolic blood pressure. This study, with an average follow-up time of 3.8 years, included the largest cohort to date, of hypertensive patients with type 2 diabetes. The results for diabetic patients confirmed that: (i) significantly fewer major cardiovascular events occurred with a target diastolic blood pressure ≤80mmHg (and mean achieved diastolic blood pressure of 81mmHg); (ii) cardiovascular mortality was significantly lower in patients with a target diastolic blood pressure ≤80 mmHg; (iii) most patients (up to 69%) required combination antihypertensive therapy to achieve target DBP; (iv) aspirin offered additional benefit for the prevention of cardiovascular events. These results may inf luence future recommendations regarding the management of hypertension in patients with type 2 diabetes.