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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The pilot phase of the trial has been started with support from the British Heart Foundation. Treatment of hypertension in patients 80 years of age or older. Having recruited large numbers of patients from Eastern Europe and China, the authors were criticized for not appreciating the increased prevalence of cerebrovascular events in these populations, when compared with adults from Western Europe — a factor which may exaggerate the potential benefit arising from active therapy [ 14 ].
Once again, the relative well being of the trial participants limits the potential applicability of these data to the general population. There were also significant reductions in rates of other secondary outcomes including fatal stroke, HF, and CV events. At 2 years, there were no biochemical differences in serum potassium, uric acid, glucose, or creatinine, although Dr.
Hypertension in the Very Elderly Trial (HYVET): protocol for the main trial.
This may reflect the relative physical well being of the trial population [ 24 ]. Equally, at the time of the second interim analysis July the relative risk of all stroke fatal and non-fatal amongst those receiving active hyvey was 0. Medical Research Council trial of treatment of hypertension in older adults: Whilst a statistically significant reduction in congestive cardiac failure was also observed unadjusted HR 0.
JNC 8 hypertension guidelinesadapted . A meta-analysis of RCT data found that treatment of hypertension in this age group was associated with a statistically significant reduction in major CV events and HF but no reduction no CV mortaltiy and an increased risk of all-cause mortality.
There was some concern during the session in Milan about whether this might be an artefact, however.
Furthermore, a failure to routinely identify vertebral fractures and difficulties in data collection may be sources of error.
The New England Journal of Medicine. Bulpitt gyvet any of the other authors.
Whilst each additional GDS point at baseline also increased these risks, the study was not tria to evaluate this association. 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. Given the log linear relationship between systolic blood pressure and clinical outcomes, the mortality and morbidity benefits seen in the trial might be a feature of systolic BP control, particularly in ISH, as opposed to achieved systolic and diastolic blood pressure.
Entry criteria include a sustained sitting systolic blood pressure of to mm Hg plus a sustained sitting diastolic pressure of 95 to mm Hg.
Treating very elderly hypertensive patients is rewarding: Formal education was protective HR 0. Influence of antihypertensive drug treatment on morbidity and mortality in patients over the age of 60 years.
The Hypertension in the Very Elderly Trial – latest data
The primary outcome was the rate of fatal or nonfatal stroke excluding TIA. Active therapy consisted of the diuretic indapamide 1. It is possible that the difference in stroke rates would have reached statistical significance had the trial not been stopped early.
At 2 years there were no significant changes in serum potassium, uric acid, glucose and creatinine between the trial arms [ 13 ]. In common with many other clinical trials in older people, the inclusion criteria also required that subjects be in relatively good physical and mental health individuals with dementia and those resident in nursing homes were excludedquestioning the applicability of the trial outcomes to the real life setting [ 1316 ]. Centres hyvt are interested in taking part should contact C.
The number of subjects who smoked cigarettes 2.
The investigators firmly challenge the idea that it is safer to leave gradually rising blood pressure in old age without treatment for fear of doing more harm than good.
More importantly, the early evidence of mortality benefit resulted in a relatively short duration of follow-up median 1. However, while treatment conferred hjvet benefits on enrolled patients, Dr.
This page was last modified on 11 Januaryat However, at the time of the final intention-to-treat analysis in Octoberthis trisl reduction in the primary outcome measure failed to show statistical significance — the reasons for which have never been elaborated.
National Center for Biotechnology InformationU. Yet the authors of the meta-analysis noted that a single, randomized controlled trial demonstrating no benefit from anti-hypertensive therapy, in this cohort, would negate the apparent benefits seen across their meta-analysis [ 11 ]. Troal this, a trend analysis from the EWPHE trial suggested that the treatment of hypertension might be less effective or even harmful to the very old aged over 80 years [ 10 ].
He was anxious not to discourage teams from reducing pressures sufficiently, which he thought was generally very desirable for improving cardiovascular mortality rates in the very elderly. Main study findings A double-blind placebo-controlled trial with recruitment centres in 13 countries, HYVET prospectively analyzed data from older adults.
HYVET also has a number of methodological issues, namely the protocol amendment which provided for the inclusion of subjects with ISH and the variable methods for measuring blood pressure.
Those on antihypertensives at baseline had their medications stopped prior to placebo run-in. Results in patients with diastolic blood pressures averaging through mm Hg. Views Read View source View history.
As a result, many benefits and risks of treating this population remain unclear.
Further Results of the Hypertension in the Very Elderly Trial (HYVET)
Bulpitt noted that nearly three-quarters of the patients in the active therapy group were receiving combination therapy, and the chemical effects of each drug likely mitigated those of the other agent.
Sociodemographic and lifestyle risk factors for incident dementia and cognitive decline in the HYVET. The s saw publication of landmark data demonstrating the benefits of anti-hypertensive therapy [ 1 — 3 ]. Thus, no significant difference was observed between the two trial arms HR 0. N Engl J Med. The trial steering group also published hjvet analysis evaluating the association of depression with cardiovascular mortality and morbidity, all-cause mortality and incident dementia.