A decreased renal function does not preclude the an adequate control of blood pressure. Results from the hot study

It has been considered that the presence of a diminished renal function could be one of the factors precluding the attainment of an adequate blood pressure control in essential hypertension. The HOT Study has included a total of 19193 patients that have been divided into three groups according to 3 different blood pressure goals (Diastolic BP 90 mmHg, 85 mmHg or 80 mmHg). This study offers an excellent opportunity to investigate whether or not the presence of a decreased renal function limits the capacity of drugs to lower BP. Parameters of renal function measured were serum creatinine levels and the determination of creatinine clearance (Cockcroft-Gault formula). Initial values disclosed similar levels of renal function in the three groups of patients. In order to investigate the influence of renal function on therapeutic response, data were analyzed in two ways: 1) patients were divided into those achieving and those not achieving the goal in each group of BP control. Renal function did not differ after 12 months of therapy between patients below or above the BP goal; 2) patients were divided according to their serum creatinine levels in four groups (< 1.2 mg/dl N = 14775; 1.2−< 1.5 N = 2461; 1.5−< 1.7 N = 212; > 1.7 N = 214) In these four groups the fall in DBP after 12 months of therapy was similar. Nevertheless, an equal control of BP in the presence of renal failure was obtained at the expense of a higher percentage of patients needing more than one drug. In summary the results of the HOT Study clearly show that renal function does not impede attaining the goal of BP control in essential hypertension.