Results of the pilot study for the Hypertension in the Very Elderly Trial.
BACKGROUND
The risks and benefits of treating hypertension in individuals older than 80 years are uncertain. A meta-analysis has suggested that a reduction in stroke events of 36% may have to be balanced against a 14% increase in total mortality.


OBJECTIVE
To report the results of the pilot study of the Hypertension in the Very Elderly Trial (HYVET), which is in progress to address these issues.


METHODS
The HYVET-Pilot was a multicentre international open pilot trial. In 10 European countries, 1283 patients older than 80 years and with a sustained blood pressure of 160-219/90-109 mmHg were allocated randomly to one of three treatments: a diuretic-based regimen (usually bendroflumethiazide; n = 426), an angiotensin-converting enzyme inhibitor regimen (usually lisinopril; n = 431) or no treatment (n = 426). The procedure permitted doses of the drug to be titrated and diltiazem slow-release to be added to active treatment. Target blood pressure was < 150/80 mmHg and mean follow-up was 13 months.


RESULTS
In the combined actively treated groups, the reduction in stroke events relative hazard rate (RHR) was 0.47 [95% confidence interval (CI) 0.24 to 0.93] and the reduction in stroke mortality RHR was 0.57 (95% CI 0.25 to 1.32). However, the estimate of total mortality supported the possibility of excess deaths with active treatment (RHR 1.23, 95% CI 0.75 to 2.01).


CONCLUSIONS
The preliminary results support the need for the continuing main HYVET trial. It is possible that treatment of 1000 patients for 1 year may reduce stroke events by 19 (nine non-fatal), but may be associated with 20 extra non-stroke deaths.
Bulpitt
Christopher J
CJ
Faculty of Medicine, Imperial College London, UK. c.bulpitt@ic.ac.uk
Beckett
Nigel S
NS
Cooke
Jonathan
J
Dumitrascu
Dan L
DL
Gil-Extremera
Blas
B
Nachev
Choudomir
C
Nunes
Maria
M
Peters
Ruth
R
Staessen
Jan A
JA
Thijs
Lut
L
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D003971:Diastole / Q000187:drug effects; D004232:Diuretics / Q000627:therapeutic use; D004311:Double-Blind Method; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D010865:Pilot Projects; D011188:Potassium / Q000097:blood; D012307:Risk Factors; D016019:Survival Analysis; D013599:Systole / Q000187:drug effects; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D015415:Biomarkers; D002121:Calcium Channel Blockers; D004232:Diuretics; D003404:Creatinine; D011188:Potassium