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New research shows important differences in the response to antihypertensive treatment depending on age and sex

May 08, 2000

HOT Study shows reduced risk of heart attacks in women, and good blood pressure control in older patients, on felodipine ER (Plendil®) - based therapy

New data from the HOT (Hypertension Optimal Treatment) Study published in the May issue of the Journal of Hypertension,1 show that women with hypertension achieve target blood pressures more easily than men and experience greater benefits from antihypertensive treatment. The data also show that older people achieved a 1-2 mm Hg lower blood pressure, had fewer adverse events and more frequently reached blood pressure targets than younger patients. The findings have important implications for approaches to hypertension management.

Unlike many cardiovascular studies, the HOT Study,2 the largest intervention study in hypertension ever completed, involved a large number of women and older people. Nearly half of the 18,790 people studied were women, and one-third were over 65 years old. The study was conducted in 26 countries. Patients were followed for an average of 3.8 years. Blood pressure reduction was achieved with a regimen of the calcium antagonist felodipine ER (Plendil®) plus an ACE inhibitor or beta blocker if required to meet blood pressure targets of < 90 mm Hg, < 85 mm Hg, or < 80 mm Hg. In addition patients were randomised to acetylsalicylic acid (ASA) 75mg daily or placebo.

The results of the age and gender differences in the response to the HOT Study blood pressure targets provide firm evidence for generally adopting an intensive approach to the treatment of hypertension in all patients. The findings provide robust evidence that the World Health Organization-International Society of Hypertension (WHO-ISH) targets of an optimal or normal blood pressure of 130/85 mm Hg in young and middle-aged hypertensives, and a target below 140/90 mm Hg3 for the elderly, can be achieved. The treatment regimen was well tolerated. Peripheral oedema was the most frequent adverse event and was more frequent in women, and in older patients.

Commenting on the results the lead author, Dr Sverre Kjeldsen, Department of Cardiology, Ullevaal University Hospital, Oslo, Norway, said: "The HOT Study shows improved outcomes with antihypertensive treatment in women, namely a greater reduction in risk of myocardial infarction with lower target diastolic blood pressure compared with men. The 1-2 mm Hg lower diastolic blood pressure observed in the HOT Study older population is also clinically important. Taken together with other studies of calcium antagonists in the elderly e.g. STOP-2,4 the HOT age and gender sub-group analysis provides clear evidence of their usefulness in effective control of hypertension in the elderly."

There were also age and gender differences in the response to acetylsalicylic acid (ASA). Risk of myocardial infarction was significantly reduced by 42% in men on a dose of 75mg ASA daily compared with placebo, whereas in women, ASA had no significant effect. A 39% reduction of myocardial infarction was observed in the older group compared with 35% in the younger group.

AstraZeneca is a major international healthcare business engaged in the research, development, manufacture and marketing of ethical (prescription) pharmaceuticals and the supply of healthcare services. It is one of the top five pharmaceutical companies in the world with healthcare sales of over $15 billion and leading positions in sales of gastrointestinal, oncology, anaesthesia including pain management, cardiovascular, central nervous system (CNS) and respiratory products. AstraZeneca was the principal sponsor of the HOT Study.

1. Kjeldsen SE, Kolloch RE, Leonetti G, Mallion J-M, Zanchetti A, et al. for the HOT Study Group. Influence of gender and age on preventing cardiovascular disease by antihypertensive treatment and acetylsalicylic acid. The HOT study. J Hypertens 2000; 18: 629-42

2. Hansson L, Zanchetti A ,Carruthers SG, Dahlöf B, Elmfeldt D, et al. 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

3. 1999 World Health Organisation -- International Society of Hypertension Guidelines for the Management of Hypertension. J Hypertens 1999; 17:151-183

4. Hansson L, Lindholm LH, Ekborn T, Dahlöf B, Lanke J, et al. for the STOP-Hypertension-2 study group. Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study. Lancet 1999; 354: 1751-56

For further information please contact:

Jonathan Wilson
Telephone 44-207-465-7079

Ingrid Warnold
AstraZeneca R&D Mölndal
Telephone 46-31-776-1000

Dag Elmfeldt
AstraZeneca R&D Mölndal
Telephone 46-31-776-1000

Ketchum UK

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