The effect of treatment based on a diuretic (indapamide) +/- ACE inhibitor (perindopril) on fractures in the Hypertension in the Very Elderly Trial (HYVET).
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.
Peters
Ruth
R
Imperial College Faculty of Medicine, Hammersmith Campus Du Cane Road, London UK. r.peters@imperial.ac.uk
Beckett
Nigel
N
Burch
Lisa
L
de Vernejoul
Marie-Christine
MC
Liu
Lisheng
L
Duggan
Joe
J
Swift
Cameron
C
Gil-Extremera
Blas
B
Fletcher
Astrid
A
Bulpitt
Christopher
C
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
D000959:Antihypertensive Agents; D004338:Drug Combinations; D010919:Placebos; C494243:indapamide, perindopril drug combination; D007190:Indapamide; D020913:Perindopril