Hypertension treatment effective even after age 80

General

Clinical Question:
Does the treatment of hypertension in persons older than 80 years improve clinical outcomes?

Bottom Line:
Treatment of hypertension in the very elderly reduces the risk of fatal stroke and death from any cause. Previous studies using high-dose diuretics and beta-blockers had not found a similar benefit, perhaps because of the adverse effects of high-dose diuretics and the lack of benefit of beta-blockers. (LOE = 1b)

Reference:
Beckett NS, Peters R, Fletcher AE, et al, for the HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008;358:1887-1898.  [PMID:18378519]

Study Design:
Randomized controlled trial (double-blinded)

Allocation:
Concealed

Setting:
Outpatient (any)

Synopsis:
Data regarding the benefit of treating hypertension in the very elderly are sparse and mixed. Although some studies have shown a reduced risk of stroke, there is also data suggesting an increase in all-cause mortality, especially with target systolic blood pressures below 140 mm Hg. In this study, 3845 patients older than 80 years with a systolic blood pressure between 160 and 199 mm Hg without medication were identified. The patients were a mix of those with systolic hypertension and systolic/diastolic hypertension. They were randomly assigned to receive sustained-release indapamide 1.5 mg daily or placebo. Patients with recent stroke, secondary or accelerated hypertension, heart failure, or renal impairment were excluded. If the target blood pressure of 150/80 mm Hg was not achieved, perindopril (2 mg or 4 mg) or matching placebo could be added. Appoximately 25% of active treatment patients were receiving indapamide alone at the end of the study; the rest were receiving indapamide and perindopril. The mean duration of follow-up was 2.1 years, with a range of 0 to 6.5 years. Patients in the active treatment group had lower rates of fatal stroke (6.5% vs 10.7%; P= .046; number needed to treat [NNT] = 24), all-cause mortality (47.2% vs 59.6%; P = .02; NNT = 8), heart failure (5.3% vs 14.8%; P <.001; NNT = 10.5), and any cardiovascular event (33.7% vs 50.6%; P < .001; NNT = 5.9). There were fewer serious adverse events in the active treatment group, as well.

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