Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension:: principal results of the hypertension optimal treatment (HOT) randomised trial
Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension:: principal results of the hypertension optimal treatment (HOT) randomised trial
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DOI：
10.1016/s0140-6736(98)04311-6
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发表时间：
1998-06-13
期刊：
影响因子：
168.9
通讯作者：
Westerling, S
中科院分区：
文献类型：
--
作者：
Hansson, L;Zanchetti, A;Westerling, S
背景 尽管进行了治疗，高血压患者心血管并发症的发生率通常高于血压正常者。血压降低不足可能是原因，但最佳目标血压尚不清楚。从未研究过乙酰水杨酸（阿司匹林）对高血压患者的影响。我们的目的是评估最佳目标舒张压以及低剂量乙酰水杨酸治疗高血压的潜在益处。方法来自 26 个国家的 18 790 名患者，年龄 50-80 岁（平均 61.5 岁）患有高血压，舒张压在 100 mm Hg 至 115 mm Hg（平均 105 mm Hg）之间，被随机分配目标舒张压压力。 6264 名患者被分配到目标压力小于或等于 90 毫米汞柱，6264 名患者被分配到小于或等于 85 毫米汞柱，6262 名患者被分配到小于或等于 80 毫米汞柱。根据五步疗法，给予非洛地平作为基线治疗，并添加其他药物。此外，9399 名患者被随机分配每天 75 毫克乙酰水杨酸（Bamycor，Astra），9391 名患者被分配安慰剂。 结果舒张压降低了 20.3 mm Hg、22.3 mm Hg 和 24.3 mm Hg，在小于或等于 90 mm Hg、小于或等于 85 mm Hg 和小于或等于80 分别为毫米汞柱目标组。主要心血管事件的发生率最低发生在舒张压平均达到 82.6 毫米汞柱时；心血管死亡风险最低发生在 86.5 毫米汞柱。进一步降低血压至这些血压以下是安全的。在糖尿病患者中，与小于或等于 90 mm Hg 的目标组相比，小于或等于 80 mm Hg 的目标组主要心血管事件减少了 51%（趋势 p=0.005）。乙酰水杨酸可将主要心血管事件减少 15% (p=0.03)，将所有心肌梗塞减少 36% (p=0.002)，但对中风没有影响。乙酰水杨酸组发生 7 例致命性出血，安慰剂组发生 8 例，两组非致命性大出血分别为 129 例和 70 例（p
Background Despite treatment, there is often a higher incidence of cardiovascular complications in patients with hypertension than in normotensive individuals. Inadequate reduction of their blood pressure is a likely cause, but the optimum target blood pressure is not known. The impact of acetylsalicylic acid (aspirin) has never been investigated in patients with hypertension. We aimed to assess the optimum target diastolic blood pressure and the potential benefit of a low dose of acetylsalicylic acid in the treatment of hypertension.Methods 18 790 patients, from 26 countries, aged 50-80 years (mean 61.5 years) with hypertension and diastolic blood pressure between 100 mm Hg and 115 mm Hg (mean 105 mm Hg) were randomly assigned a target diastolic blood pressure. 6264 patients were allocated to the target pressure less than or equal to 90 mm Hg, 6264 to less than or equal to 85 mm Hg, and 6262 to less than or equal to 80 mm Hg. Felodipine was given as baseline therapy with the addition of other agents, according to a five-step regimen. In addition, 9399 patients were randomly assigned 75 mg/day acetylsalicylic acid (Bamycor, Astra) and 9391 patients were assigned placebo.Findings Diastolic blood pressure was reduced by 20.3 mm Hg, 22.3 mm Hg, and 24.3 mm Hg, in the less than or equal to 90 mm Hg, less than or equal to 85 mm Hg, and less than or equal to 80 mm Hg target groups, respectively. The lowest incidence of major cardiovascular events occurred at a mean achieved diastolic blood pressure of 82.6 mm Hg; the lowest risk of cardiovascular mortality occurred at 86.5 mm Hg. Further reduction below these blood pressures was safe. In patients with diabetes mellitus there was a 51% reduction in major cardiovascular events in target group less than or equal to 80 mm Hg compared with target group less than or equal to 90 mm Hg (p for trend=0.005). Acetylsalicylic acid reduced major cardiovascular events by 15% (p=0.03) and all myocardial infarction by 36% (p=0.002), with no effect on stroke. There were seven fatal bleeds in the acetylsalicylic acid group and eight in the placebo group, and 129 versus 70 non-fatal major bleeds in the two groups, respectively (p