Influence of gender and age on preventing cardiovascular disease by antihypertensive treatment and acetylsalicylic acid. The HOT study

Objective We have assessed the influence of gender and age on the main outc ome results of the Hypertension Optimal Treatment (HOT) study. Design and interventions The aims of the HOT study were to study the relati onship between three levels of target office diastolic blood pressure (BP) (less than or equal to 90, less than or equal to 85 or less than or equal t o 80 mmHg) and cardiovascular (CV) events in hypertensive patients, and to examine the effects of 75 mg acetylsalicylic acid (ASA) daily versus placeb o. Setting Outpatient clinical trial in 26 countries. Patients A total of 18 790 patients (mean age 61.5 years, range 50-80) were randomized and followed for an average of 3.8 years until 71 051 patient-y ears and 683 events had occurred. Main outcome measures CV death, myocardial infarction (MI) and stroke. Results There were significantly fewer Mis in those in the lower diastolic BP target groups (3.0 versus 1.2 and 1.7 Mis/1000 patient-years, P for tren d = 0.034) in women (n = 8883), whereas the similar but smaller trend (4.1 versus 4.1 and 3.4 Mis/1000 patient-years) was not statistically significan t in men nor in the subgroup analysis of younger and older subjects. The ef fect of ASA on preventing MI was not influenced by age < 65 years (P = 0.02 ) or age greater than or equal to 65 years (P = 0.04) but was influenced by gender (P = 0.38 in women and P = 0.001 in men, lowered by 42% correspondi ng to a reduction from 5.0 to 2.9 Mis/1000 patient-years). Conclusions The data of this HOT study sub-analysis suggest somewhat differ entiated optimal gender- and age-dependent effects of anti-hypertensive and anti-platelet therapies; lowering of diastolic BP to about 80 mmHg in hype rtensive women and, in addition, the administration of 75 mg of ASA to well -treated hypertensive men appear to effectively reduce the most common card iovascular complication, i.e. myocardial infarction, in patients with essen tial hypertension, I Hypertens 2000, 18:629-642 (C) Lippincott Williams & W ilkins.