title: The effect of treatment based on a diuretic (indapamide) +/- ACE inhibitor (perindopril) on fractures in the Hypertension in the Very Elderly Trial (HYVET).
abstract: BACKGROUND
  fractures may have serious implications in an elderly individual, and fracture prevention may include a careful choice of medications.
  
  
  METHODS
  the Hypertension in the Very Elderly Trial (HYVET) was a double-blind placebo-controlled trial of a thiazide-like diuretic (indapamide 1.5 mg SR) with the optional addition of the angiotensin-converting enzyme (ACE) inhibitor (perindopril 2-4 mg). Fracture was a secondary end point of the trial.
  
  
  METHODS
  HYVET recruited participants from Eastern and Western Europe, China, Australasia, and Tunisia.
  
  
  METHODS
  all participants were > or =80 years of age and hypertensive.
  
  
  METHODS
  participants were randomised to receive a thiazide-like diuretic (indapamide 1.5 mg SR) +/- ACE inhibitor (perindopril 2-4 mg) or matching placebos. Incident fractures were validated and analysed based on time to first fracture.
  
  
  RESULTS
  there were 3,845 participants in HYVET and a total 102 reported fractures (42 in the active and 60 in the placebo group). When taking only validated first fractures, 90 were included in the analyses (38 in the active and 52 in the placebo group). Cox proportional hazard regression, adjusted for key baseline risk factors, resulted in a point estimate of 0.58 (95% CI 0.33-1.00, P = 0.0498).
  
  
  CONCLUSIONS
  despite the lowering of blood pressure, treatment with a thiazide-like diuretic and an ACE inhibitor does not increase and may decrease fracture rate.
authors.affiliation: Imperial College Faculty of Medicine, Hammersmith Campus Du Cane Road, London UK. r.peters@imperial.ac.uk
authors.forename: Ruth
authors.initials: R
authors.lastname: Peters
authors.forename: Nigel
authors.initials: N
authors.lastname: Beckett
authors.forename: Lisa
authors.initials: L
authors.lastname: Burch
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: de Vernejoul
authors.forename: Lisheng
authors.initials: L
authors.lastname: Liu
authors.forename: Joe
authors.initials: J
authors.lastname: Duggan
authors.forename: Cameron
authors.initials: C
authors.lastname: Swift
authors.forename: Blas
authors.initials: B
authors.lastname: Gil-Extremera
authors.forename: Astrid
authors.initials: A
authors.lastname: Fletcher
authors.forename: Christopher
authors.initials: C
authors.lastname: Bulpitt
mesh_terms: D000369:Aged, 80 and over; D000375:Aging; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D004338:Drug Combinations; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D015994:Incidence; D007190:Indapamide / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D020913:Perindopril / Q000008:administration & dosage* / Q000009:adverse effects; D010919:Placebos; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations; D010919:Placebos; C494243:indapamide, perindopril drug combination; D007190:Indapamide; D020913:Perindopril