Lowering Blood Pressure Benefits the Very Elderly

For hypertensive patients 80 years and older, treatment to lower blood pressure yields significant reductions in stroke, heart failure, and death, reports a study in The New England Journal of Medicine.

The placebo-controlled Hypertension in the Very Elderly Trial (HYVET) included a worldwide sample of 3845 patients 80 or older with persistent hypertension—systolic blood pressure 160 mm Hg or higher. The active treatment group received sustained-release indapamide, 1.5 mg. Those who did not reach a blood pressure of 150/80 mm Hg were further randomized to receive perindopril, 2 or 4 mg, or placebo.

At a median of 1.8 years, blood pressure was about 15/6 mm Hg lower in the indapamide/perindopril group. Active treatment was associated with a 30 percent reduction in fatal or nonfatal stroke (the primary endpoint), including a 39 percent reduction in fatal stroke. Mortality from all causes was reduced by 21 percent, cardiovascular mortality by 23 percent, and heart failure risk by 64 percent. Patients assigned to active treatment actually had fewer serious adverse events than the placebo group.

It has been unclear whether blood-pressure-lowering treatment is beneficial for patients 80 or older. However, the antihypertensive regimen evaluated in HYVET—sustained-release indapamide, plus perindopril if needed—leads to significant reductions in stroke and mortality. These benefits are achieved at a target blood pressure of 150/80 mm Hg, which was reached in nearly half of HYVET patients [Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, Stoyanovsky V, Antikainen RL, Nikitin Y, Anderson C, Belhani A, Forette F, Rajkumar C, Thijs L, Banya W and Bulpitt CJ, for the HYVET Study Group: Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358:1887–1898].