Renal function and intensive lowering of blood pressure in hypertensive participants of the Hypertension Optimal Treatment (HOT) Study

This article reports further analyses of the Hypertension Optimal Treatment (HOT) Study data with the aim to describe (1) the value of baseline serum creatinine and its clearance (estimated by Cockroft and Gault formula) as p redictors of cardiovascular events, (2) the effects of intensive lowering o f BP on cardiovascular events and renal function in patients with reduced r enal function, and (3) the effects on cardiovascular events of adding acety lsalicylic acid to antihypertensive therapy in patients with reduced renal function. The results show that (I) baseline elevation in serum creatinine and a reduction in estimated creatinine clearance are powerful predictors o f cardiovascular events and death. (2) Reduced renal function at baseline d id not preclude the desired control of BP. In contrast to patients with nor mal renal function, the incidence of major cardiovascular events did not di ffer in the three groups of patients with mild renal insufficiency randomiz ed to different diastolic BP targets. No significant changes in serum creat inine were seen at the end of the 3.8-yr treatment period in the great majo rity of patients. However, there was a small group of patients (0.58% of th e total study population) whose renal function deteriorated (increase great er than or equal to 30% over baseline and final serum creatinine concentrat ion greater than or equal to2 mg/dl) despite satisfactory reduction of dias tolic BP. (3) The results of this reanalysis of the HOT Study suggest thoug h do not prove that the association of acetylsalicylic acid with intensive antihypertensive therapy offers additional benefit in hypertensive patients with reduced renal function.