Large study demonstrates that antihypertensive treatment decreases all-cause and stroke mortality.


CHICAGO—In patients aged 80 years and older, antihypertensive treatment reduces morbidity and mortality according to results from the Hypertension in the Very Elderly (HYVET) trial.

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“HYVET shows that it is never too late to start antihypertensive therapy,” stated Nigel S. Beckett, MB, ChB, of the Imperial College in London, who reported findings here at the annual meeting of the American College of Cardiology. “We have expanded the upper age limit for treatment and shown a decrease in stroke mortality and total mortality. The benefits are seen early on and the treatment regimen was safe.”


In HYVET, investigators randomized 3,845 patients aged 80 years or older who had systolic BP of 160 mm Hg or higher to receive either the diuretic indapamide (sustained release, 1.5 mg) or matching placebo. The ACE inhibitor perindopril (2 or 4 mg) could be added to achieve a target BP of 150/80 mm Hg.


Patients were recruited from Europe, China, Australia, and Tunisia. They were instructed to stop all antihypertensive treatment and take placebo for a run-in period of two months, during which time they had two BP measurements one month apart. Then they were randomized, providing that their systolic pressure was between 160 and 199 mm Hg.


Treatment groups were well matched for demographic and clinical parameters. Mean age was 83.6 years; 60% were female; mean seated BP was 170/90.8 mm Hg at baseline; 11.8% had a CVD history. Ninety percent were known to be hypertensive, but only 65% had received antihypertensive treatment.


Benefits of treatment were seen during the first year, Dr. Beckett said. Mean follow-up was 1.8 years. By two years, mean seated BP was reduced by 15/6.1 mm Hg in the active treatment group compared with placebo. Active treatment achieved a nonsignificant 30% reduction in stroke. Treatment was associated with a significant 21% decrease in all-cause mortality but did not significantly reduce the risk of death from cardiovascular causes. The treatment group had a 64% reduced risk of heart failure.


In addition, 57% of all strokes that occurred in the trial were fatal, and treatment reduced fatal strokes by 39% as compared with placebo, Dr. Beckett said.


Study findings were presented here at the American College of Cardiology annual meeting and published in the New England Journal of Medicine (2008;358:1887-1898).