Significant Reduction in Deaths Using Blood
Pressure-Lowering Treatment in Very Elderly
Note: This story about the Hypertension in the Very
Elderly Trial (HYVET) was added in December to the SeniorJournal.com archives after it became a stop health story for 2008
March 31, 2008 - Lowering the blood pressure of
elderly patients could cut their total mortality by a fifth and their
rate of cardiovascular events by a third, according to a new study
presented today at the American College of Cardiology in Chicago and
published simultaneously in the New England Journal of Medicine. The
trial was so successful in saving lives that it was concluded early last
August to rush the data into use.
The 3,845 patient Hypertension in the Very Elderly
Trial (HYVET), which is coordinated by scientists from Imperial College
London, is the largest ever clinical trial to look at the effects of
lowering blood pressure solely in those aged 80 and over. Patients were
given either a placebo or the diuretic indapamide slow release (SR)
1.5mg, with the addition of the ACE inhibitor perindopril in tablet form
once a day.
The research shows that the benefits of treatment
include a 21% reduction in total mortality rate, a 39% reduction in
stroke mortality rate, a 64% reduction in fatal and non-fatal heart
failures and a 34% reduction in cardiovascular events. The benefits were
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-80s reduces stroke and cardiovascular events.
However, previous smaller and inconclusive studies also suggested that
whilst lowering blood pressure in those aged 80 or over reduced the
number of strokes, it did not reduce, and even possibly increased, total
mortality.
In July 2007 the trial was stopped early on the
recommendation of an independent data monitoring committee after they
observed significant reductions in overall mortality and stroke in those
receiving treatment. The final results of the trial showed a significant
reduction in stroke mortality rate, but the reduction in all strokes of
30% did not quite reach statistical significance (p=0.06) In those aged
80 and over, up to half of strokes are fatal and the reduction in fatal
strokes is an important finding.
Emeritus Professor Christopher Bulpitt, the lead
investigator on the study from the Care of the Elderly Group at Imperial
College London, said: "Before our study, doctors were unsure about
whether very elderly people with high blood pressure could see the same
benefits from treatment to lower their blood pressure as those we see in
younger people. Our results clearly show that many patients aged 80 and
over could benefit greatly from treatment. Populations are living longer
and we have growing numbers of people living well into their 80s and
beyond, so this is good news. We are very pleased that cardiovascular
events were reduced safely with a reduction in total mortality."
The researchers hope that their findings will clear
up uncertainty amongst clinicians about the benefits of treating those
aged 80 and over for high blood pressure.
Dr Nigel Beckett, the trial coordinator from the
Care of the Elderly Group at Imperial College London, added: "Many very
elderly people with high blood pressure are not being treated for it at
the moment, because doctors are unsure about whether or not treatment
will help them. We hope that following our study, doctors will be
encouraged to treat such patients in accordance with our protocol."
As the trial was stopped early, an extension
involving patients receiving active-treatment is now underway to assess
the longer term benefits of treatment.
Patients with high blood pressure (defined here as
a systolic blood pressure between 160-199 mmHg), from thirteen countries
across the world, were randomized for the double-blind,
placebo-controlled trial, which began in 2001. The mean age of
participants was 83 years and 7 months.
Patients were given either placebo or indapamide
slow release (SR) with the addition of perindopril, in tablet form once
a day as required, to achieve a target blood pressure of 150/80mmHg. The
average follow-up of patients was just over 2 years by which time 20% of
the placebo subjects and 48% of those taking medication had achieved the
target blood pressure of 150/80 mmHg. In those patients who were
followed up for longer, a larger number of patients receiving active
treatment achieved the target blood pressure
Background Information
HYVET was co-coordinated by scientists from
Imperial College London, working with colleagues around the world. The
main trial was funded by both the British Heart Foundation and by
Servier.
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