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LONDON, March 31 /PRNewswire/ -- The 3,845 patient Hypertension in theVery Elderly Trial (HYVET), which is co-ordinated by scientists from ImperialCollege London, is the largest ever clinical trial to look at the effects oflowering blood pressure solely in those aged 80 and over. Patients were giveneither a placebo or the diuretic indapamide slow release (SR) 1.5mg, with theaddition of the ACE inhibitor perindopril in tablet form once a day.
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The research shows that the benefits of treatment include a 21% (p=0.02)reduction in total mortality rate, a 39% (p=0.05) reduction in strokemortality rate, a 64% (p<0.001) reduction in fatal and non-fatal heartfailures and a 34% (p<0.001) reduction in cardiovascular events. The benefitswere apparent within the first year of follow-up.
The reduction in overall mortality was a novel and unexpected result.Earlier trials had demonstrated that reducing blood pressure in the under-80sreduces stroke and cardiovascular events. However, previous smaller andinconclusive studies also suggested that whilst lowering blood pressure inthose aged 80 or over reduced the number of strokes, it did not reduce, andeven possibly increased, total mortality.
In July 2007 the trial was stopped early on the recommendation of anindependent data monitoring committee after they observed significantreductions in overall mortality and stroke in those receiving treatment. Thefinal results of the trial showed a significant reduction in stroke mortalityrate, but the reduction in all strokes of 30% did not quite reach statisticalsignificance (p=0.06). In those aged 80 and over, up to half of strokes arefatal and the reduction in fatal strokes is an important finding.
Emeritus Professor Christopher Bulpitt, the lead investigator on thestudy from the Care of the Elderly Group at Imperial College London, said:"Before our study, doctors were unsure about whether very elderly people withhigh blood pressure could see the same benefits from treatment to lower theirblood pressure as those we see in younger people. Our results clearly showthat many patients aged 80 and over could benefit greatly from treatment.Populations are living longer and we have growing numbers of people livingwell into their 80s and beyond, so this is good news. We are very pleasedthat cardiovascular events were reduced safely with a reduction in totalmortality."
The researchers hope that their findings will clear up uncertaintyamongst clinicians about the benefits of treating those aged 80 and over forhigh blood pressure.
Dr Nigel Beckett, the trial co-ordinator from the Care of the ElderlyGroup at Imperial College London, added: "Many very elderly people with highblood pressure are not being treated for it at the moment, because doctorsare unsure about whether or not treatment will help them. We hope thatfollowing our study, doctors will be encouraged to treat such patients inaccordance with our protocol."
As the trial was stopped early, an extension involving patients receivingactive-treatment is now underway to assess the longer term benefits oftreatment.
Patients with high blood pressure (defined here as a systolic bloodpressure between 160-199 mmHg), from thirteen countries across the world,were randomised for the double-blind, placebo-controlled trial, which beganin 2001. The mean age of participants was 83 years and 7 months.
Patients were given either placebo or indapamide slow release (SR) withthe addition of perindopril, in tablet form once a day as required, toachieve a target blood pressure of 150/80 mmHg. Th
