Kidney function in the very elderly with hypertension: data from the hypertension in the very elderly (HYVET) trial.
BACKGROUND
numerous reports have linked impaired kidney function to a higher risk of cardiovascular events and mortality. There are relatively few data relating to kidney function in the very elderly.


METHODS
the Hypertension in the Very Elderly Trial (HYVET) was a randomised placebo-controlled trial of indapamide slow release 1.5mg ± perindopril 2-4 mg in those aged ≥80 years with sitting systolic blood pressures of ≥160 mmHg and diastolic pressures of <110 mmHg. Kidney function was a secondary outcome.


RESULTS
HYVET recruited 3,845 participants. The mean baseline estimated glomerular filtration rate (eGFR) was 61.7 ml/min/1.73 m(2). When categories of the eGFR were examined, there was a possible U-shaped relationship between eGFR, total mortality, cardiovascular mortality and events. The nadir of the U was the eGFR category ≥60 and <75 ml/min/1.73 m(2). Using this as a comparator, the U shape was clearest for cardiovascular mortality with the eGFR <45 ml/min/1.73 m(2) and ≥75 ml/min/1.73 m(2) showing hazard ratios of 1.88 (95% CI: 1.2-2.96) and 1.36 (0.94-1.98) by comparison. Proteinuria at baseline was also associated with an increased risk of later heart failure events and mortality.


CONCLUSIONS
although these results should be interpreted with caution, it may be that in very elderly individuals with hypertension both low and high eGFR indicate increased risk.
Imperial College London, London, UK. r.peters@imperial.ac.uk
Ruth
R
Peters
Nigel
N
Beckett
Ruth
R
Poulter
Lisa
L
Burch
Krzysztof
K
Narkiewicz
Robert
R
Fagard
Dorothea
D
Nitsch
Nan
N
Wang
Mengying
M
Li
Astrid
A
Fletcher
Christopher
C
Bulpitt
D000367:Age Factors; D000369:Aged, 80 and over; D000375:Aging; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D003692:Delayed-Action Preparations; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D007190:Indapamide / Q000627:therapeutic use; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D020913:Perindopril / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D003692:Delayed-Action Preparations; D004232:Diuretics; D007190:Indapamide; D020913:Perindopril