[A critical analysis of the Hypertension Optimal Treatment (HOT) Study (appeared in Lancet 1998; 351: 1755-1762)].
In the HOT-study 18,790 patients in 26 countries (age 50-80 years, mean age 61.5 years) with hypertension (diastolic blood pressure between 100 and 115 mm Hg--mean value 105 mm Hg) were randomised into 3 groups with different target blood pressures (90 mm Hg, 85 mm Hg, 80 mm Hg). The basic treatment was with Felodipin (5 mg q. d.): if the target pressure was not achieved, further steps were initiated: either ACE-inhibitors or -blockers were added, in a third step the Felodipindose was increased to 100 mg and in a further step the doses of ACE-inhibitors or -blockers were doubled. If target pressure was still not achieved, a diuretic was added. Furthermore half of the patients in all groups received either placebo or 75 mg acetyl-salicylic acid. To prevent cardiovascular events the best benefit was shown, when a diastolic pressure of 82.6 mm Hg was reached. Acetyl-salicylic acid showed a further benefit in preventing myocardial infarction, but not in preventing strokes.
Skrabal
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Abteilung für Innere Medizin des Krankenhauses der Barmherzigen Brüder, Graz. falko.skrabal@kfunigraz.ac.at
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D002423:Cause of Death; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D015736:Felodipine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D015736:Felodipine