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In the Hypertension Optimal Treatment (HOT) Trial, more than 19,000 patients were randomized to 3 different target blood pressure levels (less than or equal to 90 mm Hg, less than or equal to 85 mm Hg, or less than or equal to 80 mm Hg) and treated with a long-acting calcium antagonist, felodipine. ACE inhibitors, beta-blockers, and diuretics were added to reach target blood pressure levels in each of the 3 groups as needed. In the 1,501 patients with diabetes mellitus, the risk for a major cardiovascular event or myocardial infarction was lowest in the group randomized to a target blood pressure of less than or equal to 80 mm Hg. Despite the small difference in diastolic target blood pressures, there was a substantial benefit as blood pressure was lowered with treatment in the patients with diabetes mellitus. These data also support the benefits of intensive blood pressure lowering in diabetic patients with hypertension.


Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, Menard J, Rahn KH, Wedel H, Westerling S, for the HOT Study Group. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998;351:1755-1762.