Keywords: elderly, hypertension, HYVET, older adults, treatment Despite this, a trend analysis from the EWPHE trial suggested that the. The Hypertension in the Very Elderly Trial (HYVET) is a multicentre, open, randomised, controlled trial. The aim of this trial is to investigate the effect of active. Drugs Aging. ;18(3) Hypertension in the Very Elderly Trial (HYVET): protocol for the main trial. Bulpitt C(1), Fletcher A, Beckett N, Coope J.
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Hypertension — treated and untreated. This review provides an overview of the Hypertension in the Very Elderly Trial whilst also discursively evaluating the latest data. Based on the originally published data, at a median follow-up of 1.
Further Results of the Hypertension in the Very Elderly Trial (HYVET)
Starting dosage for bendroflumethiazide and lisinopril is 2. The pilot phase of the trial has been started with support from the British Heart Foundation.
Secondary outcomes included rates of fatal stroke, all-cause mortality, and CV events. Some have interpreted HYVET as a negative study, since the P value for the primary outcome of stroke did not reach statistical significance.
Whilst these results strengthen the case for early benefit arising from anti-hypertensive therapy in octogenarians, the selective exclusion criteria are questionable. Equally, at the time of the second interim analysis July the relative risk of all stroke fatal and non-fatal amongst those receiving active treatment was 0.
More recently, additional data from this cohort has been published suggesting that appropriate anti-hypertensive therapy may lead to a reduction in incident cognitive impairment and fractures, whilst a 1 year open label hyvt of the main study confirmed many of the original trial findings.
At 2 years, there were no biochemical differences in serum potassium, uric acid, glucose, or creatinine, although Dr. Bulpitt suggested that future trials that expand patient selection criteria will help better define the limits of the treatment pursued in the HYVET cohort.
These drugs have been chosen as inexpensive and appropriate representatives of their therapeutic trixl. This appeared to detect small differences between the two trial arms, in favour of treatment.
Published online Aug Usable articles Nephrology Cardiology Geriatrics. Medical Research Council trial of treatment of hypertension in older adults: The primary outcome was the rate of fatal or nonfatal stroke excluding TIA. Immediate and late benefits of treating very elderly people with hypertension: This may reflect the relative physical well being of the trial population [ 24 ].
The study — the largest international, double-blind, placebo-controlled trial of its kind — concludes that very elderly patients with hypertension should be treated, and that this brings only benefits and not additional risks.
When analyzing the 90 incident, validated fractures 38 in the active group; 52 in the placebo group and adjusting for baseline risk factors, a HR of 0. Abstract Early trials in the field of hypertension focused on adults in their fifties and sixties. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Furthermore, standing and seated BPs post-treatment were equivalent, suggesting that antihypertensive therapy was not associated with orthostatic hypotension [ 13 ].
The Hypertension in the Very Elderly Trial – latest data
It is possible that the difference in stroke rates would have reached statistical significance had the trial not been stopped early. Received Apr 30; Accepted Aug Mancia G, Grassi G. The investigators also observed a non-significant reduction in hyveet primary outcome measure, stroke, unadjusted hazard ratio HR 0. Br J Clin Pharmacol. There were also significant reductions in rates of other secondary outcomes including fatal stroke, HF, and CV events. Trjal participants were 80 years or older and had persistent hypertension defined as systolic BP of at least mm Hg.
The s saw publication of landmark data demonstrating the benefits of anti-hypertensive therapy [ 1 — 3 ]. At 2 years there were no significant changes in serum potassium, uric acid, glucose and creatinine between the trial arms [ 13 ]. The New England Journal of Medicine. Formal education was protective HR 0. As a result, many benefits and risks of treating this population remain unclear.
Introduction The s saw publication of landmark data demonstrating the benefits of anti-hypertensive therapy [ 1 — 3 ]. Beckett NS, et al. Thus, social and economic status were not adequately controlled for and reverse causality could not be excluded.
Support Center Support Center. In looking at the presence or absence of previous cardiovascular disease, only men and women out of the entire HYVET population had any prior CVD. Earlier this year, nyvet from a 1 year open label active treatment extension of HYVET were published. Influence of antihypertensive drug treatment on morbidity and mortality in patients over the age of 60 years.
Those on antihypertensives at baseline had their medications stopped prior to placebo run-in. In that hyget, some have expressed significant concerns with over-treatment of hypertension in the elderly, citing the risks of polypharmacy and the fact that elderly patients are prone to hypovolemia and orthostatic syncope, etc.
Patients are to be randomised to 3 groups- i no treatment; ii treatment with a diuretic [bendroflumethiazide bendrofluazide ]; or iii treatment with an angiotensin converting enzyme ACE inhibitor lisinopril.
Results in patients with diastolic blood pressures averaging through mm Hg. However, while treatment conferred tial benefits on enrolled patients, Dr. Antihypertensive drugs in very old people: The primary endpoint of HYVET was any fatal or nonfatal stroke, with secondary endpoints including all-cause mortality, cardiovascular mortality, cardiac death, and death from stroke.