HOT STUDY - QUALITY OF THE BLOOD-PRESSURE CONTROL AFTER 2 YEARS FOLLOW-UP

The objective of the HOT study, an international, prospective, randomi sed study was to determine the optimal level of the blood pressure und er treatment. linked with the lowest cardiovascular mortality and morb idity. The target diastolic blood pressure of 80, 85 and 90 mmHg was d etermined at the randomisation. In order to reach the target blood pre ssure, a strategy of treatment was predefined : the Ist step was felod ipine (a long acting dihydropyridine) and the next steps (if the blood pressure reduction was not enough) proposed the addition of different therapeutic classes and/or the increase of the doses of each drug. Th e blood pressure measurements were made, using the oscillometric metho d (automatic blood pressure measuring device, Hestia). The quality of the blood pressure control observed in the HOT study was verified afte r 6 months of follow-up (''Quality of the blood pressure control in th e clinical practice and in the HOT study'', for the French research gr oup of the HOT study, French hypertension meeting, Paris, December 199 4). The aim of this second evaluation was to see if the quality of thi s control was still effective in France and for all countries after 2 years of follow-up. At the inclusion, the mean diastolic blood pressur e was 106 +/- 4 mmHg in France (n = 1.574) and 105 +/- 4 mmHg for all countries (n = 18.790). The results at 24 months were the following, a ccording to the target groups : 79.9 for the less than or equal to 80 mmHg target group; 82.1 for the less than or equal to 85 mmHg target a nd 83.6 for the less than or equal to 90 mmHg target group. The percen tages of patients who reached the target blood pressure were respectiv ely 74; 80; 89 % for the 3 target groups. The number of antihypertensi ve treatments needed to reach this blood pressure control slightly inc reased in the 3 target groups between the first and the second year wi th a lower rate of monotherapy and a higher rate of bi and tritherapy. But in the 80 mmHg target group (the most strict), the monotherapy wa s used in more than half of the patients. In comparison with all count ries, France had lower number of bi and tritherapies (i.e. in the 85 m mHg target group : 38.4 % of bitherapy in France versus 45.6 % in all countries). Conclusion: after 2 years of follow-up, the quality of the blood pressure control is still good. There is a trend toward a sligh t increase in the number of antihypertensive drugs after the first yea r in the 3 target groups.