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Significant reductions in mortality shown using blood pressure-lowering treatment in very elderly
Date:3/31/2008

Lowering the blood pressure of elderly patients could cut their total mortality by a fifth and their rate of cardiovascular events by a third, according to a new study presented today (Monday 31 March) at the American College of Cardiology in Chicago and published simultaneously in the New England Journal of Medicine.

The 3,845 patient Hypertension in the Very Elderly Trial (HYVET), which is coordinated by scientists from Imperial College London, is the largest ever clinical trial to look at the effects of lowering blood pressure solely in those aged 80 and over. Patients were given either a placebo or the diuretic indapamide slow release (SR) 1.5mg, with the addition of the ACE inhibitor perindopril in tablet form once a day.

The research shows that the benefits of treatment include a 21% (p=0.02) reduction in total mortality rate, a 39% (p=0.05) reduction in stroke mortality rate, a 64% (p<0.001) reduction in fatal and non-fatal heart failures and a 34% (p<0.001) reduction in cardiovascular events. The benefits were apparent within the first year of follow-up.

The reduction in overall mortality was a novel and unexpected result. Earlier trials had demonstrated that reducing blood pressure in the under-80s reduces stroke and cardiovascular events. However, previous smaller and inconclusive studies also suggested that whilst lowering blood pressure in those aged 80 or over reduced the number of strokes, it did not reduce, and even possibly increased, total mortality.

In July 2007 the trial was stopped early on the recommendation of an independent data monitoring committee after they observed significant reductions in overall mortality and stroke in those receiving treatment. The final results of the trial showed a significant reduction in stroke mortality rate, but the reduction in all strokes of 30% did not quite reach statistical significance (p=0.06) In those aged 80 and over, up to half of strokes are fatal and the red
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Contact: Laura Gallagher
L.Gallagher@imperial.ac.uk
44-078-038-86248
Imperial College London
Source:Eurekalert

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