The “hot” study: US versus the world experiences

The hypertension optimal treatment study is a large international prospective randomized trial to investigate the “J” curve during the treatment of hypertension. The goal is to lower the diastolic blood pressure in one third of participants ≤90, the other third ≤85 and the third group to ≤80 mmHg. At closure of the recruitment 19,196 patients were enrolled world wide; 13.7% (N = 2646) from USA. Some interesting indications about medical practices emerge. In the main study subjects were receiving antihypertensive treatment when enrolled into the study and 1,833 of those from USA. The majority of the treated patients in the 74 US centers were recruited by advertisement in the communities. Percentage of patients on various categories of antihypertensive drugs was: The blood pressure of treated subjects at enrollment in the US was lower than in the world. (153± ±10 versus 161± ±9 ). These blood pressure differences do not seem to reflect milder hypertension in patients in USA. Two weeks after discontinuation of the Rx the blood pressure readings were world 170± ±4, USA 167± ±4. Percent of patients at 6 months in the study (US or world) at goal were for target≤90 = 88.3 vs 83.6%, target≤85 = 77.5 vs 71.6% and target≤80 = 68.0 vs 57.0%. The US physicians appeared ready to use more options in the 5 steps upward titration to achieve the goal The US physicians appear to favor Calcium antagonists and ACE I over beta-blockers in the Rx of hypertension. The US centers had access to patients whose blood pressure at entry was treated to lower values than in the world and during the trial the US investigators are more aggressive in achieving goals. It is not known whether these findings reflect practice patterns in the USA or whether they apply only to the investigators in the HOT study.