Subgroup and per-protocol analyses fromthe hypertension in the very elderly trial

Nigel Beckett*, Ruth Peters, Gastone Leonetti, Joe Duggan, Robert Fagard, Lut Thijs, Krzysztof Narkiewicz, Terry McCormack, Winston Banya, Astrid Fletcher, Christopher Bulpitt

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

39 Citations (Scopus)

Abstract

Background: The results of the Hypertension in the Very Elderly Trial showed positive benefits from blood pressure-lowering treatment in those aged 80 and over. Method: An analysis by the pre-specified subgroups [age, sex, history of cardiovascular disease (CVD) and initial SBP] was performed. The Hypertension in the Very Elderly Trial was a randomized, double-blind, placebo-controlled trial of 3845 participants aged 80 and over with SBPs of 160-199 mmHg and diastolic pressures below 110 mmHg recruited from Europe, China, Australasia and Tunisia. Active treatment was indapamide sustained-release 1.5mg with the addition of perindopril 2-4mg as required to reach a target blood pressure of less than 150/80 mmHg. Results: For total mortality, benefits were consistent: men [hazard ratio 0.82, 95% confidence interval (CI) 0.62-1.11], women (hazard ratio 0.77, 95% CI 0.66-0.99), those aged 80-84.9 (hazard ratio 0.76, 95% CI 0.60-0.96), those aged 85 and over (hazard ratio 0.87, 95% CI 0.64-1.20), those with a history of CVD (hazard ratio 0.76, 95% CI 0.48-1.20) and those without (hazard ratio 0.81, 95% CI 0.65-0.99), and similarly across a range of baseline SBPs. The point estimates for cardiovascular mortality, strokes, heart failure and cardiovascular events were all in favour of benefit. In the per-protocol analysis, strokes were reduced by 34% (P=0.026), total mortality by 28% (P=0.001), cardiovascular event by 37% (P<0.001) and heart failure by 72% (P<0.001). Conclusion: In hypertensive patients aged 80 or more, treatment based on indapamide (sustained-release) 1.5mg showed consistent benefits across pre-specified subgroups including those without established CVD (the majority), supporting the need for treatment even at this advanced age. There were too few aged 90 or over to determine benefit from treatment at extreme age.

Original languageEnglish
Pages (from-to)1478-1487
Number of pages10
JournalJournal of Hypertension
Volume32
Issue number7
DOIs
Publication statusPublished - Jul 2014
Externally publishedYes

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