blood pressure is common in people 80 years of age or older. It
is a major risk factor for heart disease in the very elderly people. Treatment
in this group aims at a target blood pressure of 150/80 mm Hg.
leads to an array of adverse events including stroke and heart failure.
However, the risks and benefits of early and long term treatment of
hypertension in the very elderly patients were obscure. Whether the initiation
of treatment would bring an immediate benefit in hypertensive patients who are
80 years of age or older continued to be a relevant question.
The Hypertension in the
Very Elderly Trial (HYVET) turned out to be the first of its kind trial to elucidate
the benefits of antihypertensive treatment in the very elderly hypertensives. A
total of 3845 patients from Europe, China,
Australasia, and Tunisia who were 80 years of age or older were enrolled
in this trial. Participants had a sustained
systolic blood pressure of 160 mm Hg. They were randomised to active treatment
or placebo groups. The treatment group received a diuretic drug called indapamide
. (Diuretics are drugs that
increase the flow of urine.) Another antihypertensive drug called perindopril
was added if required.
preliminary results observed were highly encouraging. The study was hence
halted prematurely in August 2007, though it had been scheduled to be completed
in 2009. Results concluded that antihypertensive
treatment was associated with reductions in stroke and all-cause mortality.
A one year extension of the HYVET was done recently.
of HYVET who were on placebo were given active blood pressure lowering treatment during
the one year extension. Those on the treatment group in the trial continued
taking the active drug. Treatment regimen was the same as in the original
of this extension trial made it clear that benefits
of antihypertensive therapy can be accrued within 12
months even in very elderly people. The beneficial effect on incidence of
complications such as stroke and heart failure is seen early, while reduction
in mortality and cardiovascular mortality took a little longer.
In light of the increasing average life expectancy, the prevention of adverse cardiovascular
events in the elderly needs attention.
- A reduction
in disability and maintenance of independence and quality of life would be of benefit.
- People aged
80 or more should have their blood pressure checked regularly.
levels of 160 mm Hg or more should be treated so as to achieve a safer level of
systolic blood pressure below 150 mm Hg.
Immediate and late benefits of treating very elderly
people with hypertension: results from active treatment extension to
Hypertension in the Very Elderly randomised controlled trial; N.Beckett et al;