[Lowering of diastolic blood pressure < or = 90 mmHg should not be attempted, except in type 2 diabetics; the 'Hypertension optimal treatment' (HOT) trial].
Recently the 'Hypertension optimal treatment' (HOT) study was reported. In this study 18,790 patients with diastolic blood pressure between 100 and 115 mmHg were randomly assigned target pressures of < or = 90, < or = 85 and < or = 80 mmHg respectively, and treated with a felodipine-based antihypertensive regimen. In all three groups an impressive fall in both diastolic and systolic blood pressures, and as a consequence very few major cardiovascular events (the primary endpoint of the study) were observed, but there was no difference in endpoint scores among the three groups. Type 2 diabetic patients fared substantially better than non-diabetic patients and they are likely to profit if their diastolic pressure is decreased below 80 mmHg. In the remaining patients rigorous maintenance of present-day standards (diastolic pressure < or = 90 mmHg) is advised. The addition of 75 mg aspirin 1 dd resulted in a modest but significant reduction of major cardiovascular events, but at the cost of increased gastrointestinal bleedings.
Wesseling
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Klinisch farmacoloog, Paterswolde.
D000328:Adult; D000368:Aged; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003971:Diastole; D015736:Felodipine / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate
D002121:Calcium Channel Blockers; D015736:Felodipine; D001241:Aspirin
Niet streven naar diastolische bloeddruk < or = 90 mmHg, behalve bij type-2-diabetici; het 'Hypertension optimal treatment' (HOT)-onderzoek.