[HOT study: quality of the blood pressure control after 2 years follow-up. Pour le Groupe français de l'étude HOT].
The objective of the HOT study, an international, prospective, randomised study was to determine the optimal level of the blood pressure under treatment, linked with the lowest cardiovascular mortality and morbidity. The target diastolic blood pressure of 80, 85 and 90 mmHg was determined at the randomisation. In order to reach the target blood pressure, a strategy of treatment was predefined: the 1st step was felodipine (a long acting dihydropyridine) and the next steps (if the blood pressure reduction was not enough) proposed the addition of different therapeutic classes and/or the increase of the doses of each drug. The blood pressure measurements were made, using the oscillometric method (automatic blood pressure measuring device, Hestia). The quality of the blood pressure control observed in the HOT study was verified after 6 months of follow-up ("Quality of the blood pressure control in the clinical practice and in the HOT study", for the French research group of the HOT study. French hypertension meeting, Paris, December 1994). The aim of this second evaluation was to see if the quality of this control was still effective in France and for all countries after 2 years of follow-up. At the inclusion, the mean diastolic blood pressure was 106 +/- 4 mmHg in France (n = 1.574) and 105 +/- 4 mmHg for all countries (n = 18.790). The results at 24 months were the following, according to the target groups: 79.9 for the < or = 80 mmHg target group; 82.1 for the < or = 85 mmHg target and 83.6 for the < or = 90 mmHg target group. The percentages of patients who reached the target blood pressure were respectively 74; 80; 89% for the 3 target groups. The number of antihypertensive treatments needed to reach this blood pressure control slightly increased in the 3 target groups between the first and the second year with a lower rate of monotherapy and a higher rate of bi and tritherapy. But in the 80 mmHg target group (the most strict), the monotherapy was used in more than half of the patients. In comparison with all countries, France had lower number of bi and tritherapies (i.e. in the 85 mmHg target group: 38.4% of bitherapy in France versus 45.6% in all countries).


CONCLUSIONS
after 2 years of follow-up, the quality of the blood pressure control is still good. There is a trend toward a slight increase in the number of antihypertensive drugs after the first year in the 3 target groups.
Herpin
D
D
Service cardiologie B, CHU La Milétrie, Poitiers.
Mallion
J M
JM
Dahan
R
R
Benkritly
A
A
Boutelant
S
S
Baguet
J P
JP
Noir-Clerc
M
M
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D004359:Drug Therapy, Combination; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D011786:Quality Control; D012307:Risk Factors
D000959:Antihypertensive Agents