April 1, 2001Journal of Hypertension
Risk assessment and treatment benefit in intensively treated hypertensive patients of the Hypertension Optimal Treatment (HOT) study
Key result
Pronounced blood pressure lowering in hypertensive patients resulted in cardiovascular event rates approximately 60% lower than expected from baseline risk, though a risk gradient persisted.
Why the study?
Does pronounced blood pressure lowering reduce cardiovascular events across different risk strata in hypertensive patients?
Population
18,790 hypertensive patients from the Hypertension Optimal Treatment study, stratified by 1999 WHO/ISH risk…
Comparison
Pronounced blood pressure lowering vs Different risk strata and expected baseline risk…
Design
Cohort
Follow-up
mean 3.8 years
Authors
Discussion
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Implication
May support intensive BP lowering across hypertension risk strata; leaves open whether pretreatment stratification refines targeting.
Study Design
Type
RCT (n=18,790)
Structured PICO
Does pronounced blood pressure lowering reduce cardiovascular events across different risk strata in hypertensive patients?
P
Population
18,790 hypertensive patients from the Hypertension Optimal Treatment (HOT) study, stratified by 1999 WHO/ISH risk criteria (0% low risk, 50% medium risk, 20.2% high risk, 29.8% very high risk)
I
Intervention
Pronounced blood pressure lowering (antihypertensive treatment)
C
Comparator
Different risk strata (medium, high, very high) and expected baseline risk from Framingham equation
O
Outcome
Incidence of cardiovascular eventshard clinical
Main Result
Effect estimate: RR 2-3
Intensive blood pressure lowering significantly reduces cardiovascular events compared to expected rates, but a residual risk gradient persists based on pretreatment risk, highlighting the need for early intervention and comprehensive risk factor management.
Cite This Study
Zanchetti et al. (2001) conducted an RCT in Hypertension (n=18,790). Pronounced blood pressure lowering vs. Expected baseline risk (Framingham equation) was evaluated on Cardiovascular events (RR 2-3). Pronounced blood pressure lowering in hypertensive patients resulted in cardiovascular event rates approximately 60% lower than expected from baseline risk, though a risk gradient persisted.