LONG-TERM CLINICAL TOLERABILITY OF THE HYPERTENSION TREATMENT IN THE HOT STUDY

The objective of the HOT study, an international, prospective, randomi sed study is to determine the optimal level of the blood pressure unde r treatment, in linked with the lowest cardiovascular mortality and mo rbidity. The target diastolic blood pressure of 80, 85 and 90 mmHg was determined at the randomisation. In order to reach the target blood p ressure, a strategy of treatment was determined : the 1st step was fel odipine (a long acting dihydropyridine) and the next steps (if the blo od pressure reduction is not enough) propose the addition of different therapeutic classes and/or the increase of each drug doses. The avail able data after 2 years of the patients follow-up allow us to evaluate the incidence of the reported side effects according to the target bl ood pressure assigned by randomisation and the number of hypertension drugs used to reach these targets. The percentage of patients with at least one side effect at 12 and 24 months of follow up are respectivel y: for the target group DBP less than or equal to 90 mmHg : 9.2 % vers us 6 %;for the target group DBP less than or equal to 85 mmHg: 8 % ver sus 4.4 %; for the target group DBP less than or equal to 80 mmHg: 7.9 % versus 4.9 %. The overall tolerability is not influenced by the tar get diastolic blood pressure but depends on the number of hypertension drugs used. At 24 months, 2.8 % of patients are under monotherapy; 7 % under bitherapy and 9.8 % under tritherapy. The incidence of the sid e effects decreases after the 1st year, but slower than between the th ird months and the first year. There is an influence of the region on the incidence of the side effects, the south European countries descri bing more side effects than France or the north European countries. Th is seems to be linked with a perception of the side effects more than with a higher rate. In conclusion, these results confirm the possibili ty to reach a targeted blood pressure using a predetermined strategy w ithout increasing dramatically the incidence of the side effects.