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Kaplan¹ recommends the time-honored goal blood pressure (BP) of 140/90 mm Hg for low-risk patients with hypertension. In line with the Sixth Report of the Joint National Committee (JNC VI), he advocates a target BP of 130/80 mm Hg for diabetic patients with hypertension.² Findings from the Hypertension Optimal Treatment (HOT) trial are cited as justification for this lower target.³ However, the evidence from the HOT trial is scientifically weak. In the HOT trial, the diabetic subgroup was identified in secondary analysis. Secondary analysis does not provide proof of effect. Secondary analysis generates hypotheses that require subsequent testing in a prospective trial.

The primary prespecified end point of the HOT trial was a lower major cardiovascular event rate (nonfatal myocardial infarction [MI], nonfatal stroke, and cardiovascular death) for patients randomized to the lowest goal diastolic BP.³ This end point was not achieved. If the diabetic group was the prospectively specified . . . [Full Text of this Article]