Key result
Aggressive antihypertensive treatment to a diastolic BP ≤80 mm Hg did not reduce cardiovascular events compared to 85 or 90 mm Hg, whereas aspirin 75 mg/day reduced major events by 15%.
Why the study?
Does aggressive blood pressure lowering or aspirin reduce cardiovascular events in hypertensive patients?
RCT
Does aggressive blood pressure lowering or aspirin reduce cardiovascular events in hypertensive patients?
In hypertensive patients, aggressive diastolic blood pressure lowering did not reduce cardiovascular events overall (though it did in diabetic patients), while low-dose aspirin significantly reduced major cardiovascular events.
Standard diastolic targets suffice over aggressive lowering; leaves open aspirin's net benefit pending contemporary RCTs.
In the Hypertension Optimal Treatment (HOT) study, hypertensive patients who were randomly assigned to undergo antihypertensive treatment to achieve a goal diastolic blood pressure of 80 mm Hg or lower did not experience fewer cardiovascular events than did patients who received treatment with goal pressures of 85 or 90 mm Hg. Such aggressive antihypertensive treatment was safe and well tolerated, and did result in fewer cardiovascular events in the subset of patients with diabetes. All patients were randomly assigned to take aspirin 75 mg/day or placebo, and patients in the aspirin group had a 15% lower rate of major cardiovascular events and myocardial infarctions than did patients who received placebo. This finding establishes the efficacy of aspirin in preventing strokes and myocardial infarctions in hypertensive patients.
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Vidt et al. (1999) conducted an RCT in Hypertension. Aggressive antihypertensive treatment vs. Goal diastolic BP of 85 or 90 mm Hg was evaluated on Cardiovascular events. Aggressive antihypertensive treatment to a diastolic BP ≤80 mm Hg did not reduce cardiovascular events compared to 85 or 90 mm Hg, whereas aspirin 75 mg/day reduced major events by 15%.
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