Mallion J M, Dahan R, Boutelant S, Benkritly A, Baguet J P, Noir-Clerc M
Service médecine interne et cardiologie, CHU Grenoble.
Arch Mal Coeur Vaiss. 1997 Aug;90(8):1165-8.
The objective of the HOT study, an international, prospective, randomised study is to determine the optimal level of the blood pressure under treatment, in linked with the lowest cardiovascular mortality and morbidity. The target diastolic blood pressure of 80, 85 and 90 mmHg was determined at the randomisation. In order to reach the target blood pressure, a strategy of treatment was determined: the 1st step was felodipine (a long acting dihydropyridine) and the next steps (if the blood pressure reduction is not enough) propose the addition of different therapeutic classes and/or the increase of each drug doses. The available data after 2 years of the patients follow-up allow us to evaluate the incidence of the reported side effects according to the target blood pressure assigned by randomisation and the number of hypertension drugs used to reach these targets. The percentage of patients with at least one side effect at 12 and 24 months of follow-up are respectively: for the target group DBP < or = 90 mmHg: 9.2% versus 6%; for the target group DBP < or = 85 mmHg: 8% versus 4.4%; for the target group DBP < or = 80 mmHg: 7.9% versus 4.9%. The overall tolerability is not influenced by the target diastolic blood pressure but depends on the number of hypertension drugs used. At 24 months, 2.8% of patients are under monotherapy; 7% under bitherapy and 9.8% under tritherapy. The incidence of the side effects decreases after the 1st year, but slower than between the third months and the first year. There is an influence of the region on the incidence of the side effects, the south European countries describing more side effects than France or the north European countries. This seems to be linked with a perception of the side effects more than with a higher rate. In conclusion, these results confirm the possibility to reach a targeted blood pressure using a predetermined strategy without increasing dramatically the incidence of the side effects.
HOT研究是一项国际性、前瞻性、随机研究，其目的是确定治疗中与最低心血管死亡率和发病率相关的最佳血压水平。随机分组时确定的目标舒张压分别为80、85和90mmHg。为达到目标血压，确定了一种治疗策略：第一步使用非洛地平（一种长效二氢吡啶类药物），接下来的步骤（如果血压降低不够）建议添加不同治疗类别药物和/或增加每种药物剂量。对患者进行2年随访后的现有数据，使我们能够根据随机分配的目标血压以及为达到这些目标所使用的高血压药物数量，评估所报告副作用的发生率。随访12个月和24个月时至少出现一种副作用的患者百分比分别为：目标舒张压≤90mmHg组：9.2%对6%；目标舒张压≤85mmHg组：8%对4.4%；目标舒张压≤80mmHg组：7.9%对4.9%。总体耐受性不受目标舒张压影响，而是取决于所使用的高血压药物数量。在24个月时，2.8%的患者接受单一疗法；7%接受联合两种药物治疗，9.8%接受联合三种药物治疗。副作用发生率在第1年后下降，但比第3个月至第1年期间下降得慢。地区对副作用发生率有影响，南欧国家报告的副作用比法国或北欧国家更多。这似乎与对副作用的认知有关，而非发生率更高。总之，这些结果证实了使用预定策略达到目标血压而不显著增加副作用发生率的可能性。
