Target blood pressure in the treatment of essential hypertension

Several prospective studies demonstrate an increased risk of major cardiova scular events with rising diastolic blood pressure values starting at level s of 76 mmHg. However, concerns exist that too vigorous blood pressure redu ction may result in increased cardiovascular risk. The emerging issue of ta rget blood pressure in the treatment of essential hypertension has been rec ently addressed in the Hypertension Optimal Treatment (HOT) study. 18,790 p atients with essential hypertension were randomized to three diastolic targ et blood pressure groups of less than or equal to 90, less than or equal to 85 and less than or equal to 80 mmHg and followed for a mean of 3.8 years. Additionally, patients were randomized to treatment with acetylsalicylic a cid (75 mg/day) or placebo. In all target blood pressure groups substantial blood pressure reductions were achieved and antihypertensive treatment was well tolerated. The three target blood pressure groups did not differ sign ificantly in the number of major cardiovascular events. The number of myoca rdial infarctions tended to be lower in the target blood pressure group les s than or equal to 80 mmHg than in the target group less than or equal to 9 0 mmHg (p = 0.05). In the subgroup of hypertensive patients with non-insuli n-dependent diabetes mellitus, significantly lower cardiovascular mortality (p < 0.02) and a significantly lower number of major cardiovascular events (p < 0.01) were observed in the target blood pressure group less than or e qual to 80 mmHg as compared with the target group less than or equal to 90 mmHg. Treatment with acetylsalicylic acid resulted in a significant reducti on of major cardiovascular events. These results show that lowering diastol ic blood pressure to values clearly below 90 mmHg does not result in an unf avorable outcome for patients with essential hypertension but may rather de crease the risk of myocardial infarction. Reducing diastolic blood pressure to less than 80 mmHg is particularly beneficial for patients with non-insu lin-dependent diabetes mellitus. Addition of acetylsalicylic acid to antihy pertensive treatment further reduces cardiovascular risk.