title: Treatment of hypertension in patients 80 years of age or older.
abstract: BACKGROUND
  Whether the treatment of patients with hypertension who are 80 years of age or older is beneficial is unclear. It has been suggested that antihypertensive therapy may reduce the risk of stroke, despite possibly increasing the risk of death.
  
  
  METHODS
  We randomly assigned 3845 patients from Europe, China, Australasia, and Tunisia who were 80 years of age or older and had a sustained systolic blood pressure of 160 mm Hg or more to receive either the diuretic indapamide (sustained release, 1.5 mg) or matching placebo. The angiotensin-converting-enzyme inhibitor perindopril (2 or 4 mg), or matching placebo, was added if necessary to achieve the target blood pressure of 150/80 mm Hg. The primary end point was fatal or nonfatal stroke.
  
  
  RESULTS
  The active-treatment group (1933 patients) and the placebo group (1912 patients) were well matched (mean age, 83.6 years; mean blood pressure while sitting, 173.0/90.8 mm Hg); 11.8% had a history of cardiovascular disease. Median follow-up was 1.8 years. At 2 years, the mean blood pressure while sitting was 15.0/6.1 mm Hg lower in the active-treatment group than in the placebo group. In an intention-to-treat analysis, active treatment was associated with a 30% reduction in the rate of fatal or nonfatal stroke (95% confidence interval [CI], -1 to 51; P=0.06), a 39% reduction in the rate of death from stroke (95% CI, 1 to 62; P=0.05), a 21% reduction in the rate of death from any cause (95% CI, 4 to 35; P=0.02), a 23% reduction in the rate of death from cardiovascular causes (95% CI, -1 to 40; P=0.06), and a 64% reduction in the rate of heart failure (95% CI, 42 to 78; P<0.001). Fewer serious adverse events were reported in the active-treatment group (358, vs. 448 in the placebo group; P=0.001).
  
  
  CONCLUSIONS
  The results provide evidence that antihypertensive treatment with indapamide (sustained release), with or without perindopril, in persons 80 years of age or older is beneficial. (ClinicalTrials.gov number, NCT00122811 [ClinicalTrials.gov].).
authors: Care of the Elderly, Division of Medicine, Imperial College London, United Kingdom.
authors: Nigel S
authors: NS
authors: Beckett
authors: Ruth
authors: R
authors: Peters
authors: Astrid E
authors: AE
authors: Fletcher
authors: Jan A
authors: JA
authors: Staessen
authors: Lisheng
authors: L
authors: Liu
authors: Dan
authors: D
authors: Dumitrascu
authors: Vassil
authors: V
authors: Stoyanovsky
authors: Riitta L
authors: RL
authors: Antikainen
authors: Yuri
authors: Y
authors: Nikitin
authors: Craig
authors: C
authors: Anderson
authors: Alli
authors: A
authors: Belhani
authors: Françoise
authors: F
authors: Forette
authors: Chakravarthi
authors: C
authors: Rajkumar
authors: Lutgarde
authors: L
authors: Thijs
authors: Winston
authors: W
authors: Banya
authors: Christopher J
authors: CJ
authors: Bulpitt
mesh_terms: D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000401:mortality; D007190:Indapamide / Q000009:adverse effects / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D020913:Perindopril / Q000009:adverse effects / Q000627:therapeutic use; D020521:Stroke / Q000401:mortality / Q000517:prevention & control*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004232:Diuretics; D007190:Indapamide; D020913:Perindopril