Do we need to treat the arterial hypertension in very older people? The results of the HYVET trial (the HYpertension in the Very Elderly Trial) Review article

Abstract

The article presents the new results of the Hypertension in the Very Elderly Trial (HYVET) – the large randomized clinical study assessing the benefits and risks of treating very elderly hypertensive patients (≥80 years). Until now, the benefits of the blood pressure lowering therapy in this population were unclear, because some epidemiological studies suggested inverse association between blood pressure level and risk of death.

Entry criteria was a systolic blood pressure of 160–199 mmHg. Active treatment consisted of diuretic indapamid SR 1,5 mg with addition of angiotensin-converting-enzyme inhibitor (perindopril 2 to 4 mg) to reach a target blood pressure below 150/80 mmHg. The primary end point was fatal or nonfatal stroke. Median followup was 1,8 years.At 2 years, the mean sitting blood pressure was 15,0/6,1 mmHg lower in the active-treatment group (n=1933) than in the placebo group (n=1912). The active treatment was correlated with a 30% reduction in the rate of fatal or nonfatal stroke (p=0,06), a 39% reduction in the rate of death from stroke (p=0,05), a 21% reduction in the rate of death from any cause (p=0,02), a 23% reduction in the rate of death from cardiovascular causes (p=0,06), and a 64% reduction in the rate of heart failure (p <0,001).

The study proved that antihypertensive treatment in persons 80 years of age or older with indapamide  (SR), with or without perindopril, is beneficial.