TY - JOUR
T1 - Subgroup and per-protocol analyses fromthe hypertension in the very elderly trial
AU - Beckett, Nigel
AU - Peters, Ruth
AU - Leonetti, Gastone
AU - Duggan, Joe
AU - Fagard, Robert
AU - Thijs, Lut
AU - Narkiewicz, Krzysztof
AU - McCormack, Terry
AU - Banya, Winston
AU - Fletcher, Astrid
AU - Bulpitt, Christopher
PY - 2014/7
Y1 - 2014/7
N2 - 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.
AB - 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.
KW - Aged 80 and over
KW - Clinical trial
KW - Hypertension
KW - Indapamide
UR - http://www.scopus.com/inward/record.url?scp=84903850252&partnerID=8YFLogxK
U2 - 10.1097/HJH.0000000000000195
DO - 10.1097/HJH.0000000000000195
M3 - Article
SN - 0263-6352
VL - 32
SP - 1478
EP - 1487
JO - Journal of Hypertension
JF - Journal of Hypertension
IS - 7
ER -