Kolloch R E, Rahn K H
Medizinische Klinik, Krankenanstalten Gilead, Bielefeld.
Dtsch Med Wochenschr. 1998 Jan 2;123(1-2):1-5. doi: 10.1055/s-2007-1023890.
The prospective, randomized multicentre HOT study (Hypertension Optimal Treatment) is at present being undertaken in 26 countries. The cardinal questions to be answered were: (1) the relationship between three targeted diastolic pressures (< or = 90, < or = 85 and < or = 80 mm Hg, respectively) and cardiovascular morbidity and mortality rates among hypertensives; and (2) the effect of low dosage aspirin (75 mg daily) on morbidity and mortality rates, compared with a placebo.
A total of 19,193 patients (9056 women, 10,137 men; age range 50-80 years) with a diastolic blood pressure of > or = 100 to < or = 115 mm Hg were randomized. Antihypertensive treatment was begun with the calcium-channel blocker felodipine (5 mg once daily; step 1). When the target could not be reached at this dosage, an angiotensin-converting enzyme inhibitor (ACEI) or beta-receptor blocker was added (stage two), after which felodipine, 10 mg daily, could be given, if necessary (step 3). Any necessary changes in dosage (step 4) were made according to a prescribed plan. As fifth and final step a diuretic could be additionally administered. One-year results are now available for all patients and reported here. Results of older patients (> or = 65 years, n = 6113) were compared to those of younger patients (< 65 years, n = 13,080).
Average diastolic pressure in the previously < or = 90 mm Hg group had been reduced to 86 mm Hg, in the < or = 85 group to 83 mm Hg, and in the < or 80 mm Hg group to 81 mm Hg. The percentage proportion of patients in whom the targeted pressures had been reached after 12 months of treatment were: 84% for the < 90 mm Hg group, 72% in the < 85 mm Hg group and 57% in the < 80 mm Hg group. In a subgroup of elderly patients (> 65 years, n = 6113) the corresponding percentage proportions were higher: 86%, 76% and 61%. Side effects were noted only rarely, despite the intensive treatment (> 65 years and < 65 years): ankle oedema in 2.6% and 3.0%; and cough in 1.3 and 0.8%, an overall incidence of > or = 1%. The same treatment (with felodipine) was still being given after one year to 88% of all patients.
These results after one year indicate that most patients well tolerate consistent blood pressure reduction. This raises the hope that the primary questions of the study can be answered.
前瞻性、随机多中心HOT研究（高血压最佳治疗研究）目前正在26个国家开展。需要回答的主要问题是：（1）高血压患者中三种目标舒张压（分别为≤90、≤85和≤80 mmHg）与心血管发病率和死亡率之间的关系；（2）与安慰剂相比，低剂量阿司匹林（每日75 mg）对发病率和死亡率的影响。
共有19193例患者（9056例女性，10137例男性；年龄范围50 - 80岁），舒张压≥100至≤115 mmHg，被随机分组。抗高血压治疗从钙通道阻滞剂非洛地平（每日5 mg；第1步）开始。当此剂量无法达到目标时，加用血管紧张素转换酶抑制剂（ACEI）或β受体阻滞剂（第2阶段），之后如有必要可给予每日10 mg的非洛地平（第3步）。根据规定方案进行任何必要的剂量调整（第4步）。作为第5步也是最后一步，可额外给予利尿剂。目前所有患者的1年结果均已获得并在此报告。将老年患者（≥65岁，n = 6113）的结果与年轻患者（<65岁，n = 13080）的结果进行了比较。
之前目标为≤90 mmHg组的平均舒张压降至86 mmHg，≤85 mmHg组降至83 mmHg，<80 mmHg组降至81 mmHg。治疗12个月后达到目标血压的患者百分比为：<90 mmHg组为84%，<85 mmHg组为72%，<80 mmHg组为57%。在老年患者亚组（>65岁，n = 6113）中，相应的百分比更高：86%、76%和61%。尽管进行了强化治疗（>65岁和<65岁），但副作用很少见：踝部水肿在>65岁组和<65岁组分别为2.6%和3.0%；咳嗽分别为1.3%和0.8%，总体发生率≥1%。1年后，所有患者中有88%仍在接受相同的治疗（使用非洛地平）。
1年的这些结果表明，大多数患者对持续降低血压耐受性良好。这增加了有望回答该研究主要问题的希望。
