Treatment of Hypertension in Patients 80 Years of Age or Older
Nigel S. Beckett, M.B., Ch.B., Ruth Peters, Ph.D., Astrid E. Fletcher, Ph.D., Jan A. Staessen, M.D., Ph.D., Lisheng Liu, M.D., Dan Dumitrascu, M.D., Vassil Stoyanovsky, M.D., Riitta L. Antikainen, M.D., Ph.D., Yuri Nikitin, M.D., Craig Anderson, M.D., Ph.D., Alli Belhani, M.D., Françoise Forette, M.D., Chakravarthi Rajkumar, M.D., Ph.D., Lutgarde Thijs, M.Sc., Winston Banya, M.Sc., Christopher J. Bulpitt, M.D., for the HYVET Study Group
Background Whether the treatment of patients with hypertensionwho are 80 years of age or older is beneficial is unclear. Ithas been suggested that antihypertensive therapy may reducethe risk of stroke, despite possibly increasing the risk ofdeath.
Methods We randomly assigned 3845 patients from Europe, China,Australasia, and Tunisia who were 80 years of age or older andhad a sustained systolic blood pressure of 160 mm Hg or moreto receive either the diuretic indapamide (sustained release,1.5 mg) or matching placebo. The angiotensin-converting–enzymeinhibitor perindopril (2 or 4 mg), or matching placebo, wasadded if necessary to achieve the target blood pressure of 150/80mm Hg. The primary end point was fatal or nonfatal stroke.
Results The active-treatment group (1933 patients) and the placebogroup (1912 patients) were well matched (mean age, 83.6 years;mean blood pressure while sitting, 173.0/90.8 mm Hg); 11.8%had a history of cardiovascular disease. Median follow-up was1.8 years. At 2 years, the mean blood pressure while sittingwas 15.0/6.1 mm Hg lower in the active-treatment group thanin the placebo group. In an intention-to-treat analysis, activetreatment was associated with a 30% reduction in the rate offatal or nonfatal stroke (95% confidence interval [CI], –1to 51; P=0.06), a 39% reduction in the rate of death from stroke(95% CI, 1 to 62; P=0.05), a 21% reduction in the rate of deathfrom any cause (95% CI, 4 to 35; P=0.02), a 23% reduction inthe rate of death from cardiovascular causes (95% CI, –1to 40; P=0.06), and a 64% reduction in the rate of heart failure(95% CI, 42 to 78; P<0.001). Fewer serious adverse eventswere reported in the active-treatment group (358, vs. 448 inthe placebo group; P=0.001).
Conclusions The results provide evidence that antihypertensivetreatment with indapamide (sustained release), with or withoutperindopril, in persons 80 years of age or older is beneficial.(ClinicalTrials.gov number, NCT00122811
[ClinicalTrials.gov]
.)
Source Information
From Imperial College London (N.S.B., R.P., R.L.A., W.B., C.J.B.) and the London School of Hygiene and Tropical Medicine (A.E.F.) — both in London; the University of Leuven, Leuven, Belgium (J.A.S., L.T.); the Beijing Hypertension League Institute, Beijing (L.L.); Spitalul Judetean Cluj, Clinica Medical 2, Cluj, Romania (D.D.); the National Transport Multi-Profile Hospital, Sofia, Bulgaria (V.S.); the University of Oulu, Oulu, Finland (R.L.A.); the State Scientific Research Institute of Internal Medicine, Novosibirsk, Russia (Y.N.); the George Institute for International Health, Sydney (C.A.); L'Etablissement Public de Santé Charles Nicolle, Service de Cardiologie, Tunis, Tunisia (A.B.); Hôpital Broca, University Paris V, Paris (F.F.); and the Brighton and Sussex Medical School, Brighton, United Kingdom (C.R.). This article (10.1056/NEJMoa0801369) was published at www.nejm.org on March 31, 2008.
Address reprint requests to Dr. Beckett at Care of the Elderly, Division of Medicine, Imperial College London, Du Cane Rd., London W12 ONN, United Kingdom.
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2, Cluj, Romania (D.D.); the National Transport Multi-Profile Hospital, Sofia, Bulgaria (V.S.); the University of Oulu, Oulu, Finland (R.L.A.); the State Scientific Research Institute of Internal Medicine, Novosibirsk, Russia (Y.N.); the George Institute for International Health, Sydney (C.A.); L'Etablissement Public de Santé Charles Nicolle, Service de Cardiologie, Tunis, Tunisia (A.B.); Hôpital Broca, University Paris V, Paris (F.F.); and the Brighton and Sussex Medical School, Brighton, United Kingdom (C.R.). 
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