"Hypertension Treatment in the Very Elderly".The New England Journal of Medicine. 2008. 358(18):1887-1898.
Links to original sources: Wiki Journal Post Full Journal Article
Contents 1Clinical Question 2Bottom Line 3Major Points 4Guidelines 5Design 6Population 6.1Inclusion Criteria 6.2Exclusion Criteria 6.3Baseline Characteristics 7Interventions 8Outcomes 8.1Primary Outcome 8.2Secondary Outcomes 9Criticisms 10Funding 11Further Reading
Does antihypertensive treatment in patients 80 years of age or older lead to a reduction in the rate of fatal or nonfatal stroke without significantly increasing the risk of death?
Antihypertensive treatment with indapamide (sustained release), with or without perindopril, significantly reduces the risks of death from stroke and death from any cause in very elderly patients with hypertension.
The question of whether to treat hypertension in patients who are 80 years of age or older was uncertain, with concerns about an increase in mortality despite a potential reduction in stroke risk. The HYVET study aimed to address this uncertainty by assessing the benefits and risks of antihypertensive treatment in this age group.
Current guidelines do not directly reflect the results from this study, as they typically address a general adult population with hypertension, with less focus specifically on those 80 years and older.
Multicenter, double-blind, parallel-group, randomized, placebo-controlled trial.
N=3,845 patients aged 80 years or older.
Inclusion Criteria - 80 years of age or older - Persistent hypertension with a sustained systolic blood pressure of 160 mm Hg or more
Exclusion Criteria - Contraindications to trial medications - Secondary hypertension - Recent hemorrhagic stroke, heart failure requiring antihypertensive medication, or significant renal impairment
Baseline Characteristics - Patients were well matched with a mean age of 83.6 years and mean seated blood pressure of 173.0/90.8 mm Hg - 11.8% with a history of cardiovascular disease - 6.9% with diabetes
- Patients received either indapamide (sustained release, 1.5 mg) or matching placebo - Perindopril (2 or 4 mg) or matching placebo could be added to achieve the target blood pressure of 150/80 mm Hg
Primary Outcome - 30% reduction in the rate of fatal or nonfatal stroke (P=0.06)
- 39% reduction in the rate of death from stroke (P=0.05) - 21% reduction in the rate of death from any cause (P=0.02) - 23% reduction in the rate of death from cardiovascular causes (P=0.06) - 64% reduction in the rate of heart failure (P<0.001) - Fewer serious adverse events in the active treatment group (P=0.001)
- It is unclear if the results are generalizable to more frail elderly populations - The true cause of death can be difficult to establish in the very elderly, especially when they are not monitored in their last hours of life and autopsies are not commonly performed
Supported by grants from the British Heart Foundation and the Institut de Recherches Internationales Servier.
The full text and supplementary information can be reviewed for more detailed findings and data interpretation.