Ruilope LM, Hansson L, Zanchetti A, on behalf of the HOT
Study Group
Does renal function influence the response to
antihypertensive agents? Results from the HOT study
16th Scientific Meeting of the International Society of Hypertension
ISH Abstract Book
(Jun) 16: 1996
It has been argued by several authors that the presence a decreased
renal function is a predictor of poorer therapeutical response to
antihypertensive drugs. The HOT Study has included a total of 19193
patients that have been divided into three groups according to 3
different blood pressure goals (diastolic BP 90 mmHg, 85 mmHg or 80
mmHg). This study is an excellent opportunity to investigate whether
or not the presence of a decreased renal function limits the capacity
of drugs to lower BP. Parameters of renal function measured were serum
creatinine levels and the determination of creatinine clearance
(Cockcroft-Gault formula).
Initial values disclosed similar levels of
renal function in the three groups of patients. The expected changes
of creatinine and its clearance with increasing age were seen and as
expected, older age was accompanied by a higher proportion of cases
with renal impairment. In order to investigate the influence of renal
function on therapeutic response, data were analyzed in two ways: 1)
patients were divided into those achieving and those not achieving the
goal in each group of BP control. Renal function did not differ after
12 months of therapy between patients below or above the BP goal; 2)
patients were divided according to their serum creatinine levels in
four groups (< 1.2 mg/dl; 1.2- < 1.5 ; 1.5-< 1.7 ; greater than
1.7) In these four groups the fall in DBP
after 12 months of therapy was similar. Nevertheless, an equal control
of BP in the presence of renal failure was obtained at the expense of
a higher percentage of patients needing more than one drug.
In summary
the results of the HOT Study clearly show that renal function does not
impede attaining the goal of BP control in essential hypertension
(Carmine Zoccali, M.D, Reggio Calabria, Italy).
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16th Scientific Meeting of the International Society of Hypertension
H: Pathophysiology :
Kidney in hypertension
H: Drug therapy :
Multiple drugs, synergy