Objective: We have assessed the influence of gender and age on the main outcome results of the Hypertension Optimal Treatment (HOT) study.
Design and interventions: The aims of the HOT study were to study the relationship between three levels of target office diastolic blood pressure (BP) (≤ 90, ≤ 85 or ≤ 80 mmHg) and cardiovascular (CV) events in hypertensive patients, and to examine the effects of 75 mg acetylsalicylic acid (ASA) daily versus placebo.
Setting: Outpatient clinical trial in 26 countries.
Patients: A total of 18 790 patients (mean age 61.5 years, range 50–80) were randomized and followed for an average of 3.8 years until 71 051 patient-years and 683 events had occurred.
Main outcome measures: CV death, myocardial infarction (MI) and stroke.
Results: There were significantly fewer MIs in those in the lower diastolic BP target groups (3.0 versus 1.2 and 1.7 MIs/1000 patient-years, P for trend = 0.034) in women (n = 8883), whereas the similar but smaller trend (4.1 versus 4.1 and 3.4 MIs/1000 patient-years) was not statistically significant in men nor in the subgroup analysis of younger and older subjects. The effect of ASA on preventing MI was not influenced by age <65 years (P = 0.02) or age >65 years (P = 0.04) but was influenced by gender (P = 0.38 in women and P = 0.001 in men, lowered by 42% corresponding to a reduction from 5.0 to 2.9 MIs/1000 patient-years).
Conclusions: The data of this HOT study sub-analysis suggest somewhat differentiated optimal gender- and age- dependent effects of anti-hypertensive and anti-platelet therapies; lowering of diastolic BP to about 80 mmHg in hypertensive women and, in addition, the administration of 75 mg of ASA to well-treated hypertensive men appear to effectively reduce the most common cardiovascular complication, i.e. myocardial infarction, in patients with essential hypertension.