The Hypertension Optimal Treatment (HOT) Study in the United States

Abstract

The international Hypertension Optimal Treatment Study has yet to be completed but preliminary analysis of data has revealed trends that suggest that physicians in the United States treat hypertension much more aggressively than their foreign colleagues. At the onset of the study, the previously-treated US patients had blood pressures that were substantially lower than those of patients in other participating countries. However, after the washout period, the blood pressures of the US patients became the same as those of their foreign counterparts. This suggests that physicians in the United States aim for target blood pressures that are lower than those generally achieved in other countries. After participants of the HOT study were treated for 6 months, the blood pressure levels achieved in US patients were lower than those achieved in their foreign counterparts. Furthermore, US physicians moved their patients more quickly up the step care protocol, suggesting that they were much more aggressive in adding new drugs to treatment regimen than were physicians from other participating countries. These findings strongly suggest that United States physicians treat hypertension much more aggressively, and the fact that mortality trends in US hypertensive patients have decreased over the past decade lends further support for this consensus.