Key result
Targeting DBP <=80 mmHg raises CV mortality ~36% in nondiabetics but lowers it in diabetics.
Why the study?
It remains necessary to define the level of diastolic blood pressure at or below 90 mmHg at which maximal reduction in cardiovascular mortality is obtained for nondiabetic hypertensive patients.
Does targeting a diastolic blood pressure <=80 mmHg compared to <=90 mmHg reduce cardiovascular mortality in nondiabetic and diabetic hypertensive patients?
RCT (n=18,700)
Randomized
Yes
Does targeting a diastolic blood pressure <=80 mmHg compared to <=90 mmHg reduce cardiovascular mortality in nondiabetic and diabetic hypertensive patients?
Intensive diastolic blood pressure lowering to <=80 mmHg is beneficial for cardiovascular mortality in diabetic patients but may be harmful in nondiabetic hypertensive patients.
Targeting DBP ≤80 mmHg was associated with higher CV mortality in nondiabetics; leaves open optimal diastolic targets for prospective trials.
OBJECTIVE: To use published Hypertension Optimal Treatment (HOT) Study data to evaluate changes in cardiovascular mortality in nondiabetic hypertensive patients according to the degree of reduction in their diastolic blood pressure. METHODS: In the HOT Study, 18,700 patients from various centers were allocated at random to groups having different objectives of for diastolic blood pressure: </=90 (n=6264); </=85 (n=6264); </=80mmHg (n=6262). Felodipine was the basic drug used. Other antihypertensive drugs were administered in a sequential manner, aiming at the objectives of diastolic blood pressure reduction. RESULTS: The group of nondiabetic hypertensive subjects with diastolic pressure</=80mmHg had a cardiovascular mortality ratio of 4.1/1000 patients/year, 35.5% higher than the group with diastolic pressure </=90mmHg (cardiovascular mortality ratio, 3.1/1000 patients/year). In contrast, diabetic patients allocated to the diastolic pressure objective group of </=80mmHg had a 66.7% reduction in cardiovascular mortality (3.7/1000 patients/year) when compared with the diastolic pressure group of </=90mmHg (cardiovascular mortality ratio, 11.1/1000 patients/year). CONCLUSION: The results indicate that in hypertensive diabetic patients reduction in diastolic blood pressure to levels </=80mmHg decreases the risk of fatal cardiovascular events. It remains necessary to define the level of diastolic blood pressure </=90mmHg at which maximal reduction in cardiovascular mortality is obtained for nondiabetics.
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Lopes et al. (2001) conducted an RCT in Hypertension (n=18,700). Diastolic blood pressure target </=80 mmHg vs. Diastolic blood pressure target </=90 mmHg was evaluated on Cardiovascular mortality (35.5% higher). A diastolic blood pressure target of <=80 mmHg increased cardiovascular mortality in nondiabetics (4.1 vs 3.1/1000 pt-yrs) but reduced it in diabetics (3.7 vs 11.1/1000 pt-yrs) compared to <=90 mmHg.
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