Morbidity and Mortality Benefits of Antihypertensive Therapy Shown for All Major Subgroups in Elderly: Presented at ESH

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Title: Morbidity and Mortality Benefits of Antihypertensive Therapy Shown for All Major Subgroups in Elderly: Presented at ESH
URL: http://www.pslgroup.com/dg/223D6A.htm
Doctor's Guide
June 19, 2008

By Betty S. Riggs

BERLIN -- June 19, 2008 -- Significant benefits of antihypertensive therapy for mortality and cardiovascular events are seen in elderly patients regardless of gender, age, previous cardiovascular disease (CVD), or initial level of systolic blood pressure (BP), according to new data from the Hypertension in the Very Elderly Trial (HYVET).

Nigel Beckett, MD, Imperial College London, London, United Kingdom, and colleagues reported their findings here on June 19 at the 18th Scientific Meeting of the European Society of Hypertension (ESH).

The HYVET trial was conducted at 195 sites in 13 countries (including Europe, China, Australasia, and Tunisia) and included 3,845 patients aged >80 years who had sustained systolic BP >160 mm Hg.

Patients were excluded from the study if they were not hypertensive, had a history of stroke in the 6 months prior to study entry, had been diagnosed with dementia, or required daily nursing care.

Randomised patients received either sustained-release indapamide 1.5 mg (n = 1,933) or placebo (n = 1,912). If they did not achieve the target blood pressure (BP) of 150/80 mm Hg, perindopril 2 to 4 mg or matching placebo could be added to the active and placebo treatments, respectively.

The primary endpoint was fatal or nonfatal stroke. The primary analysis was intention-to-treat (ITT). The prespecified subgroups that were analysed included gender, age (80-84 years, >85 years), history of cardiovascular disease (CVD), and baseline systolic BP.

At baseline, patients' mean age was 83.6 years (range 80-105 years), 60.3% were women, and 11.8% had a history of cardiovascular disease. At baseline, 4.6% were 90 years or older. Mean baseline sitting BP was 173/90.8 mm Hg.

After 2 years of follow-up, BP was lower by 15/6.1 mm Hg in the active-treatment group compared with the placebo group.

Median duration of follow-up was 1.8 years. The trial was stopped early by the data monitoring committee because of a significant reduction in the primary endpoint as well as a decrease in mortality.

In the primary analysis, treatment with indapamide, with or without perindopril, was associated with a 30% reduction in the rate of fatal or nonfatal stroke, a 39% reduction in deaths from stroke, a 21% reduction in deaths from any cause, a 23% reduction in deaths from cardiovascular causes, and a 64% reduction in the rate of heart failure.

Similar benefits were seen for all subgroups with regard to cardiovascular events.

Dr. Beckett stated, "One interesting aspect about HYVET is that prior trials had an under-representation of women, whereas HYVET included 60% females. Based on the subgroup analyses from the trial, treatment of elderly hypertensive patients was certainly beneficial in patients up to age 90, in men and women, and in patients with or without a history of cardiovascular disease."

The researchers concluded that antihypertensive treatment with indapamide plus perindopril, if needed, produced significant benefits or positive trends for mortality and cardiovascular events in elderly hypertensive patients regardless of sex, age, previous CVD, or initial systolic BP.

The findings of this study added further support for the treatment of hypertension in the elderly, the researchers concluded.

The main results of HYVET were published in the May 1 issue of New England Journal of Medicine.

[Presentation title: Benefits in Total Mortality and Cardiovascular Events by Major Subgroups in the Hypertension in the Very Elderly Trial (HYVET). Abstract PS38]

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