Hypertension Optimal Treatment (HOT) study: A brilliant concept, but a qualified success

Background to the study. The Hypertension Optimal Treatment (HOT) study was designed to answer two questions: whether low-dose aspirin (75 mg/day) is effective in the primary prevention of myocardial infarction, without an increase in cerebral haemorrhage in hypertensive patients whose blood pressure is well controlled, and whether there are additional benefits with a progressive reduction of diastolic blood pressure from 90 mmHg to below 80 mmHg. Successes. In a landmark outcome, low-dose aspirin was indeed shown to be effective in the primary prevention of myocardial infarction. Moreover, the study has shed light on many important issues for blood pressure lowering in the treatment of hypertension, providing an excellent demonstration that with aggressive combination therapy, the elevated blood pressure in hypertensive subjects can be lowered and maintained in the normotensive range in over 90% of cases. Disappointment. The biggest disappointment was that the intention to treat analysis failed to demonstrate a significant difference between the three randomized target blood pressure groups for the majority of cardiovascular events.