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(Hypertension. 1998;31:1014-1020.)
© 1998 American Heart Association, Inc.

Scientific Contributions

Hypertension Optimal Treatment (HOT) Study

Home Blood Pressure in Treated Hypertensive Subjects

Sverre E. Kjeldsen; Thomas Hedner; Kenneth Jamerson; Stevo Julius; William E. Haley; Miguel Zabalgoitia; Amir R. Butt; S. Noor Rahman; Lennart Hansson; ; for the HOT Study Group

From the Division of Cardiology, Ullevaal University Hospital, Oslo, Norway (S.E.K.); the Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg (T.H.); and Clinical Hypertension Research, University of Uppsala, Uppsala (L.H.), Sweden; the Division of Hypertension, University of Michigan Medical Center (Ann Arbor) (K.J., S.J.); Mayo Clinic, Jacksonville, Fla (W.E.H.); the Division of Cardiology, University of Texas Health Science Center at San Antonio (M.Z.); and the Division of Renal Diseases and Hypertension, University of Texas Health Science Center at Houston (A.R.B, S.N.R.).

Correspondence to Sverre E. Kjeldsen, MD, PhD, Division of Cardiology, Department of Internal Medicine, Ullevaal Hospital, N-0407 Oslo, Norway. E-mail sverrekj{at}ulrik.uio.no

Abstract—The Hypertension Optimal Treatment Study is a prospective trial conducted in 26 countries. The aims are to (1) evaluate the relationship between three levels of target office diastolic blood pressure (BP) (80, 85, or 90 mm Hg) and cardiovascular morbidity and mortality in hypertensive patients and (2) examine the effects on cardiovascular morbidity and mortality of 75 mg aspirin daily versus placebo. A total of 19 193 patients between 50 and 80 years of age had been randomized by the end of April 1994. Treatment was initiated with felodipine 5 mg daily, and additional therapy was given in accordance with a set protocol. The present substudy of 926 patients performed in nine countries aimed to (1) compare home with office BP in a representative subsample of the HOT population after the titration of treatment was completed and (2) clarify whether the separation into the target groups could be expanded into the out-of-office setting. The differences between office and home measurements in diastolic BP of 0.2 mm Hg (SD, 9; 95% confidence interval, -0.36 to 0.81; P=.40) and systolic BP of 0.5 mm Hg (SD, 15; 95% confidence interval, -0.53 to 1.46; P=.21) were not significant. The group differences in home BP were 1.9 mm Hg (80 versus 85) and 1.2 mm Hg (85 versus 90) for diastolic BP (F=11.69; ANOVA, P<.0001) and 2.6 and 2.1 mm Hg for systolic BP (F=8.44, P=.0002). Thus, office and home BPs measured with the same semiautomatic device are comparable in treated hypertensive subjects in the HOT Study, and the separation into the target groups based on office readings prevails at home.

Key Words: antihypertensive agents • blood pressure monitoring • cardiovascular diseases • clinical trials • hypertension, white coat

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