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. 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.

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