William W. Hung, MD, MPH; Rosanne M. Leipzig, MD, PhD
In patients ≥ 80 years of age with persistent hypertension, what are the benefits and risks of antihypertensive therapy?
Randomized placebo-controlled trial (Hypertension in the Very Elderly Trial [HYVET]).
Blinded (patients, clinicians, and outcome adjudication committee).*
Median 1.8 years.
195 centers in Europe, China, Australasia, and Tunisia.
3845 patients ≥ 80 years of age (mean age 84 y, 60% women) with persistent hypertension (mean sitting blood pressure [BP] 173/91 mm Hg). Exclusion criteria included accelerated or secondary hypertension, hemorrhagic stroke in the past 6 months, heart failure, gout, and dementia.
Sustained-release indapamide, 1.5 mg daily, with perindopril, 2 or 4 mg daily, added if needed to reach targets of systolic BP < 150 mm Hg and diastolic BP < 80 mm Hg (n = 1933) or placebo (n = 1912).
Stroke, heart failure, any cardiovascular event, and death from any cause, cardiovascular cause, cardiac cause, or stroke.
99.6% (intention-to-treat analysis).
Antihypertensive treatment reduced risks for heart failure, any cardiovascular event, and death from stroke or any cause (Table). At 2 years, target BP was achieved by 48% of the antihypertensive treatment group and 20% of the placebo group.
In patients ≥ 80 years of age with persistent hypertension, antihypertensive therapy with indapamide and perindopril reduced all-cause mortality.
Antihypertensive therapy vs placebo in patients ≥ 80 years of age with persistent hypertension‡
‡Abbreviations defined in Glossary. RRR, NNT, and CI calculated from data in article.
§Stroke, myocardial infarction, heart failure, or death from cardiovascular cause.
Hung WW, Leipzig RM. Antihypertensive therapy with indapamide and perindopril reduced mortality in patients ≥ 80 years. Ann Intern Med. ;149:JC2–10. doi: 10.7326/0003-4819-149-4-200808190-02010
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Published: Ann Intern Med. 2008;149(4):JC2-10.
Cardiology, Coronary Risk Factors, Hypertension, Nephrology.
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