HOT study recommends new blood pressure lows

Lowering diastolic blood pressure below the current targets can reduce stroke and heart attack risks, especially for diabetics. Currently, the recommended level for diastolic pressure is 90 mm Hg. A recent study, called the Hypertension Optimal Treatment (HOT) trial, reveals that even an eight-point reduction can make a difference.

Cardiologist Nicholas Tsapatsaris, MD, who coordinated the Burlington, MA-based Lahey Clinic’s participation in the trial, says, "Based on research findings, it appears that lowering the number from 90 mm Hg to 82 mm Hg can save lives in terms of reducing the numbers of deaths from heart attack and stroke." He adds that according to a related study, a patient’s quality of life suffers no negative impact from the eight-point reduction.

Subject categories

The subjects were randomly placed in three target (diastolic) blood pressure groups: 90 mm Hg, 85 mm Hg or 80 mm Hg. Out of the 724 cardiovascular events analyzed, the incidence of heart attacks was 84 in the 90 mm Hg group, 64 in the 85 mm Hg group and 61 in the 80 mm Hg group. The findings were drawn from a five-year follow-up of 18,790 patients in 26 countries.

Other key points of interest:

• Patients with diabetes and a diastolic blood pressure of 90 mm Hg were more susceptible to cardiovascular disease-related deaths than those with diastolic blood pressure of 82 mm Hg.

• Taking aspirin in addition to high blood pressure medication further reduced the risk of death from cardiovascular disease.

• A majority of subjects required combinations of different drugs to reach an 82 mm Hg diastolic reading.

[For more details, see Hansson L, Zanchetti A, Carruthers SG, et al. 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 1998; 351:1,755-1,762.]