Renal Function and Intensive Lowering of Blood Pressure in... : Journal of the American Society of Nephrology (original) (raw)

Hemodynamics, Hypertension, and Vascular Regulation

Renal Function and Intensive Lowering of Blood Pressure in Hypertensive Participants of the Hypertension Optimal Treatment (HOT) Study

RUILOPE, LUIS M.*; SALVETTI, ANTONIO†; JAMERSON, KENNETH‡; HANSSON, LENNART§; WARNOLD, INGRID∥; WEDEL, HANS¶; ZANCHETTI, ALBERTO§§

*Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain

†Clinica Medica, University of Pisa, Italy

‡Division of Hypertension, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan

§Clinical Hypertension Research, Department of Public Health and Social Sciences, University of Uppsala, Uppsala, Sweden

∥AstraZeneca R&D, Mo[Combining Diaeresis]lndal, Sweden

¶Nordic School of Public Health, Go[Combining Diaeresis]teborg, Sweden

§§Centro di Fisiologia Clinica e Ipertensione, University of Milan, Ospedale Maggiore di Milano and Instituto Auxologico Italiano, Milan, Italy.

Correspondence to Dr. Luis M. Ruilope, Unidad de Hipertension, Hospital 12 de Octubre, 28041 Madrid, Spain. Phone: +34-91-390-82-84; Fax: +34-91-576-56-44; E-mail: [email protected]

Accepted July 24, 2000

Received January 28, 2000

Abstract

This article reports further analyses of the Hypertension Optimal Treatment (HOT) Study data with the aim to describe (1) the value of baseline serum creatinine and its clearance (estimated by Cockroft and Gault formula) as predictors of cardiovascular events, (2) the effects of intensive lowering of BP on cardiovascular events and renal function in patients with reduced renal function, and (3) the effects on cardiovascular events of adding acetylsalicylic acid to antihypertensive therapy in patients with reduced renal function. The results show that (1) baseline elevation in serum creatinine and a reduction in estimated creatinine clearance are powerful predictors of cardiovascular events and death. (2) Reduced renal function at baseline did not preclude the desired control of BP. In contrast to patients with normal renal function, the incidence of major cardiovascular events did not differ in the three groups of patients with mild renal insufficiency randomized to different diastolic BP targets. No significant changes in serum creatinine were seen at the end of the 3.8-yr treatment period in the great majority of patients. However, there was a small group of patients (0.58% of the total study population) whose renal function deteriorated (increase ≥30% over baseline and final serum creatinine concentration ≥2 mg/dl) despite satisfactory reduction of diastolic BP. (3) The results of this reanalysis of the HOT Study suggest though do not prove that the association of acetylsalicylic acid with intensive antihypertensive therapy offers additional benefit in hypertensive patients with reduced renal function.