Herpin D, Mallion J M, Benkritly A, Baguet J P, Tremel F
Service de cardiologie, CHU La Milétrie, Poitiers.
Arch Mal Coeur Vaiss. 1998 Aug;91(8):1043-8.
The international, prospective, randomized HOT study was aimed at determining the influence of a targeted BP reduction on cardiovascular morbidity and mortality. Patients were randomly allocated to 3 DBP targets (< 80, < 85, < 90 mmHg). In addition, the impact of a coprescription of aspirin was studied. The BP target had to be reached within 3 months, according to a well-defined strategy : felodipine 5 mg o.d. as a 1st intention drug, 1, 2 or 3 additional drugs, if necessary, on the following steps. BP measurements were made, using an oscillometric automatic device (Hestia). From April 1992 to October 1994, 18,790 patients with an age range 50-80 years, coming from 26 countries, entered the study. The data collected on the 36th month were in agreement with those obtained on the 12th and the 24th months. Baseline DBP was reduced by 21, 23 and 25 mmHg in the 90, 85 and 80 mmHg target groups, respectively. The rate of patients whose DBP reached the target, obviously increased from the 3rd to the 12th month: from 43 to 56%, 60 to 70%, 74 to 83% in the 90, 85 and 80 mmHg, target groups, respectively. From the 2nd to the 3rd year, BP control was further improved, with a slightly higher rate of controlled patients in the elderly (age > 60 y), especially in the 80 mmHg target group. From inclusion to the 3rd month, one-drug treated patients decreased, whereas 2- or 3-drug treated patients increased. Felodipine-treated patients decreased on the 36th month, but remained over 80%. From the 6th to the 36th month, additional prescription of a betablocker or an ACE-inhibitor increased from 36 to 39%, and from 23 to 28%, respectively; moreover, the side-effects rate decreased from 10.5 to 3.6%, with a special decline in ankle edema from 4 to 1%. In conclusion, the BP reduction observed on the 36th month was of the same extent as that observed in the first months. It seems obviously possible to reach a targeted DBP and to maintain it over time, along with a good acceptability of the treatment. Targeted DBP could be more easily achieved in elderly patients, possibly due to a better drug compliance.
国际前瞻性随机化高血压优化治疗（HOT）研究旨在确定目标血压降低对心血管发病率和死亡率的影响。患者被随机分配至3个舒张压目标（<80、<85、<90 mmHg）。此外，还研究了联合使用阿司匹林的影响。根据明确的策略，必须在3个月内达到血压目标：首选非洛地平5 mg每日1次，必要时在后续步骤中加用1、2或3种其他药物。使用示波自动装置（赫斯提亚）进行血压测量。1992年4月至1994年10月，来自26个国家的18790名年龄在50 - 80岁的患者进入该研究。第36个月收集的数据与第12个月和第24个月获得的数据一致。90、85和80 mmHg目标组的基线舒张压分别降低了21、23和25 mmHg。舒张压达到目标的患者比例在第3个月至第12个月明显增加：90、85和80 mmHg目标组分别从43%增至56%、60%增至70%、74%增至83%。从第2年到第3年，血压控制进一步改善，老年患者（年龄>60岁）中血压控制良好的患者比例略高，尤其是在80 mmHg目标组。从纳入研究到第3个月，单药治疗的患者减少，而两药或三药治疗的患者增加。第36个月时，非洛地平治疗的患者减少，但仍超过80%。从第6个月到第36个月，β受体阻滞剂或血管紧张素转换酶抑制剂的额外处方分别从36%增至39%，从23%增至28%；此外，副作用发生率从10.5%降至3.6%，踝部水肿从4%降至1%尤为明显。总之，第36个月观察到的血压降低程度与最初几个月观察到的相同。显然有可能达到目标舒张压并长期维持，同时治疗的可接受性良好。老年患者可能更容易达到目标舒张压，这可能是由于更好的药物依从性。
