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November 8, 2000
News this month In searching for ways to reduce the risk of heart attacks and strokes among people with high blood pressure, medical researchers studied 19,000 patients to determine what the target blood pressure should be. Are there significant health benefits to be gained from reducing blood pressure below the long-held baseline of 140/90 and at what point is the benefit highest? Medical researchers studied 19,000 patients
to determine what the target blood pressure should be.
The Hypertension Optimal Treatment (HOT) Study is one of the largest intervention trials ever completed in hypertension. It was conducted from October 1992 to August 1997 and involved 18,790 patients in 26 countries. The study also looked at the effectiveness of aspirin in helping to control hypertension. Results were published in The Lancet. Subjects given three blood pressure targets Results of the study can be applied
equally to both genders.
Participants were randomly assigned to three groups in which the target diastolic blood pressure was 90, 85 or 80 mm Hg. About 53 percent of patients were being treated for hypertension prior to the study. All previous antihypertensive medications were stopped. To help patients reduce their blood pressure, felodipione, a long-acting calcium channel blocker, was used. Angiotensin converting enzyme (ACE) inhibitors and beta-blockers were added to the regimen of about two-thirds of the subjects to help them attain their diastolic blood pressure goal. For the aspirin study, 9,399 patients were randomly assigned 75 mg/day of aspirin, and 9,391 were assigned a placebo. A 30 percent reduction in events including
death was observed at a mean diastolic blood pressure of 82.6.
Study findings The most impressive and dramatic aspect of the study was the effect on diabetics for whom cardiovascular disease is the major cause of death. Diabetics in this study had a 2.5 times greater risk of having an event associated with elevated blood pressure, even with blood pressure targeted at less than 90 mm Hg, compared with the general population. Aggressive treatment resulted in a 51 percent reduction in risk of heart attack and stroke in the group using 80 mm Hg as a target versus the group using 90 mm Hg as a target. The addition of aspirin reduced major cardiovascular events by
15 percent and heart attacks specifically by 36 percent. 
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 Yale-New Haven was recognized this year by U.S. News & World Report for its programs in cardiology and cardiac surgery. |
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Study shows blood pressure control vitally important The HOT Study, published in British journal The Lancet, was not widely reported in the U.S., but it is a very important study with treatment implications for millions of people. As many as 50 million Americans have high blood pressure, and the numbers are expected to increase as the Baby Boomers approach senior status and as obesity and sedentary lifestyles continue to rise. "Controlling blood pressure
is one of the best things we can do to protect our health."
High blood pressure or hypertension is called the silent killer because it often creates no symptoms until the damage is done. Elevated blood pressure causes the heart to work harder than normal, making both the heart and arteries more prone to injury. High blood pressure increases risk of:
When high blood pressure exists with obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack or stroke increases several times. "Medications. . .are effective
in dramatically lowering blood pressure."
The good news is pharmaceutical companies are developing more and better medications to treat high blood pressure, so physicians have more tools to help their patients control high blood pressure. Although medications were not the focus of the HOT Study, its results indicate they are effective in dramatically lowering blood pressure in both men and women from various racial and cultural backgrounds and across a wide age span. "There are significant health
benefits to be gained by bringing [blood] pressure. . .[down]
to 138.5/82.6.…"
How low can we go? The study also disproved one theory that lowering blood pressure too much might result in worse outcomes for some patients—those with severe heart disease or the very elderly. In fact, although lowering blood pressure further (e.g. 120/70) did not seem to give further benefit, it also did not pose any additional risk even in the 3,000 subjects who showed evidence of significant coronary artery disease. Many physicians believe it’s unrealistic to try to achieve a diastolic blood pressure below 80, but the study shows that with appropriate medication, blood pressure can be lowered to this level in the majority of patients. Extra benefits for diabetics What have we learned?
Controlling blood pressure is one of the best things we can do
to protect our health. I advise everyone to have regular blood
pressure checks. Regular exercise and weight control will help,
but if you are diagnosed with high blood pressure, be sure and
talk with your physician about what can be done to reduce it.
Dr. Setaro is an attending cardiologist at Yale-New Haven Hospital and Yale-New Haven Heart Center, as well as an associate professor of medicine and director of the Cardiovascular Disease Prevention Center at the Yale University School of Medicine. |
