Raveau-Landon C
Laboratories Astra France, Nanterre.
Arch Mal Coeur Vaiss. 1995 Aug;88(8):1179-81.
A previous investigation of the French League against Hypertension has shown that only 27% of the hypertensives aged below 64 years and 19% of those aged above 64 years have their BP controlled under treatment (BP < 140/90 mmHg). The international, prospective, randomised HOT study aims at assessing the optimal diastolic BP (DBP) level during active antihypertensive treatment to reduce at the best the cardiovascular morbidity and mortality. The study is on-going, with a completion of inclusions. The BP measurements are performed by oscillometric method with the D2 international BP device, HESTIA. At enrollment, only 52% of the hypertensives were treated, their mean BP level being 161/99 mmHg +/- 18/9 mmHg (n = 10,005). On randomisation, two weeks after the treatment withdrawal, BP was 170/106 +/- 15/4 mmHg. Six months later, under treatment, BP was 150/84 +/- 10/7 mmHg with a mean decrease of 11/15 mmHg compared to values under previous treatment. Depending on the randomisation groups which are defined by different DBP objectives, 87.5 to 92.2% of the patients have a BP normalisation (DBP < or = 90 mmHg) after one year of treatment. Five explanations may be proposed for the better BP control observed in the study compared to the results at inclusion, reflecting the general practice: (1) the fact that the patient is free to participate and has been informed may have improved the compliance, (2) the patient's follow-up was reinforced during the first weeks, (3) the protocol is based on the treatment initiation by a dihydropyridine with a long duration of action: felodipine, (4) the BP objectives are rigorously defined by a DBP between 80 and 90 mmHg depending on the randomisation group whereas in general practice, the physician may have a smoother objective mainly aiming at improving tolerability, (5) the larger use of a bi-therapy. CONCLUSION. The more ambitious aims of BP control (DBP < or = 90, 85, 80 mmHg) in this study have induced a treatment intensification with a better BP control.
法国高血压防治联盟此前的一项调查显示，64岁以下的高血压患者中只有27%、64岁以上的患者中只有19%在接受治疗后血压得到控制（血压<140/90 mmHg）。国际前瞻性随机HOT研究旨在评估积极抗高血压治疗期间的最佳舒张压（DBP）水平，以最大程度降低心血管发病率和死亡率。该研究正在进行中，入组工作已完成。血压测量采用示波法，使用D2国际血压测量设备HESTIA进行。入组时，只有52%的高血压患者接受了治疗，他们的平均血压水平为161/99 mmHg±18/9 mmHg（n = 10,005）。随机分组时，在停止治疗两周后，血压为170/106±15/4 mmHg。六个月后，接受治疗时，血压为150/84±10/7 mmHg，与之前治疗时的值相比平均下降了11/15 mmHg。根据由不同DBP目标定义的随机分组，87.5%至92.2%的患者在治疗一年后血压恢复正常（DBP≤90 mmHg）。与入组时的结果相比，该研究中观察到的更好的血压控制可能有五种解释，反映了一般情况：（1）患者自由参与且已被告知这一事实可能提高了依从性；（2）在最初几周加强了对患者的随访；（3）方案基于使用长效二氢吡啶类药物开始治疗：非洛地平；（4）根据随机分组，DBP在80至90 mmHg之间严格定义了血压目标，而在一般情况下，医生的目标可能更宽松，主要旨在提高耐受性；（5）更多地使用了联合治疗。结论。本研究中更具雄心的血压控制目标（DBP≤90、85、80 mmHg）促使了治疗强化并实现了更好的血压控制。
