Reduction of stroke and all-cause mortality in the very elderly using antihypertensive treatment: results from the HYVET trial

They trial was lead by Nigel Beckett from the University College London, UK. He indicated that the findings demonstrated that, “it is never too late to start antihypertensive medication.” Beckett explained that previous results had been inconclusive, owing to the under-representation of those 80 years of age or above in clinical trials. Epidemiologic data have even suggested that higher blood pressure (BP) levels may be protective in the very elderly, although this could reflect risks from therapy or conditions associated with BP reduction. The Hypertension in the Very Elderly Trial (HYVET) included 3485 patients over the age of 80 years with systolic (S)BP 160–199 mmHg and diastolic (D)BP of 95–109 mmHg, no severe postural hypotension, and standing SBP greater than or equal to 140 mmHg. Individuals with standing SBP less than 140 mmHg, stroke in the last 6 months, dementia or daily nursing care were excluded. The patients were enrolled in an international, open-label study and randomly assigned to treatment with indapamide, with or without additional perindopril, or placebo. The average age of patients was 84 years at baseline with a mean entry BP level of 173/91 mmHg; around 8.5% of the patients were diagnosed with orthostatic hypotension; a third had isolated systolic hypertension; and 65% were currently or had previously taken antihypertensive medication. Those assigned to active treatment received the sustained-release formulation of indapamide at 1.5 mg daily, with addition of perindopril, if needed, first at 0.2 mg, and then 0.4 mg daily to achieve the target BP of 150/80 mmHg.