Influence of gender and age on preventing cardiovascular disease by antihypertensive treatment and acetylsalicylic acid. The HOT study

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. (C) Lippincott Williams and Wilkins.