THE HOT STUDY - EFFICACY AND TOLERABILITY ON THE 36TH MONTH

The international, prospective, randomized HOT study was aimed at dete rmining the influence of a targeted BP reduction on cardiovascular mor bidity and mortality. Patients were randomly allocated to 3 DBP target s (< 80, < 85, < 90 mmHg). In addition, the impact of a coprescription of aspirin was studied. The BP target had to be reached within 3 mont hs, according to a well-defined strategy: felodipine 5 mg o.d, as a 1 st intention drug, 1, 2 or 3 additional drugs, if necessary, on the fo llowing steps. BP measurements were made, using an oscillometric autom atic 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 tho se 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, respect ively. The rate of patients whose DBP reached the target, obviously in creased 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 slig htly higher rate of controlled patients in the elderly (age > 60 y), e specially in the 80 mmHg target group. From inclusion to the 3rd month , one-drug treated patients decreased, whereas 2- or 3-drug treated pa tients increased. Felodipine-treated patients decreased on the 36th mo nth, but remained over 80 %. From the 6th to the 36th month, additiona l 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 ed ema from 4 to 1 %. In conclusion, the BP reduction observed on the 36t h month was of the same extent as that observed in the first months. I t 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.