It is never too late to start antihypertensive treatment in patients 80 years of age or older, suggests a British study published in BMJ.
Elevated 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.
AdvertisementHypertension 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.
The 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.
Participants 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 trial.
Results 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.
- Sustained 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.
Reference: 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; BMJ 2012;344:d7541