Hypertension Optimal Treatment study

• aim - to measure the effect of incremental blood pressure on morbidity and mortality
  
  
• study design - 18 790 people randomised to treatment aimed at reducing blood pressure to 90, 85 or 80 mm Hg. Treatment consisted of a calcium channel blocker (taken by approximately 80% of patients), plus, if necessary, an ACE inhibitor (40%), a beta blocker (30%) and a diuretic (20%). Also patients were randomised to aspirin prophylaxis or placebo. The mean age of patients in the trial was 61.5 y and the mean diastolic pressure 105 mm Hg
  
  
• Results
  • lowest risk of major cardiovascular events occurred at a mean blood pressure of 139/83 mmHg
  • lowest risk of cardiovascular mortality occurred at mean blood pressure of 140/87 mmHg
  • lowest risk of stroke when blood pressure lower than 142/80mm Hg
  • aspirin treatment reduced major cardiovascular events by 15%; aspirin treatment also reduced all myocardial infarction by 36%; aspirin treatment did not reduce the risk of stroke
    
    
• Conclusions
  • first evidence for an overall benefit of low-dose aspirin in hypertensive patients
  • analysis of results based on achieved blood pressure indicates that optimal blood pressure is about 140/85 mmHg

Reference:

• Prescriber (1998), 9(16), 23.