The Hypertension Optimal Treatment Study: what did it give us?

The Hypertension Optimal Treatment study was a large, randomized, multicenter study to determine the answers to two questions: 1) what is the optimal target blood pressure to be sought in the treatment of patients with moderate hypertension? and 2) does low dose aspirin therapy decrease morbidity and mortality in patients with hypertension? After 3.8 years of follow-up for the almost 19,000 patients, the following conclusions from the study could be ascertained 1) lowering diastolic blood pressure in patients with diabetes to levels below 80 mm Hg decreases the risk of major cardiovascular events and cardiovascular mortality compared with lowering it to "normal" (< 90 mm Hg) levels. It may lower total mortality, but this study was not powered for this end point; 2) aspirin therapy, in patients with hypertension, is safe and decreases major cardiovascular events and acute myocardial infarction; 3) there does not appear to be an additional effect on cardiovascular mortality or overall mortality below that observed with a reduction of diastolic blood pressure to less than 90 mm Hg for the population as a whole; and 4) the lowest cardiovascular event rate for the population as a whole was achieved at a diastolic blood pressure of 83 mm Hg. Several limitations to this study exist, including the low event rate achieved and the generalizability of this study to the average nondiabetic patient with hypertension seen in clinical practice.