title: Subgroup and per-protocol analyses from the Hypertension in the Very Elderly Trial.
abstract: BACKGROUND
  The results of the Hypertension in the Very Elderly Trial showed positive benefits from blood pressure-lowering treatment in those aged 80 and over.
  
  
  METHODS
  An analysis by the pre-specified subgroups [age, sex, history of cardiovascular disease (CVD) and initial SBP] was performed. The Hypertension in the Very Elderly Trial was a randomized, double-blind, placebo-controlled trial of 3845 participants aged 80 and over with SBPs of 160-199 mmHg and diastolic pressures below 110 mmHg recruited from Europe, China, Australasia and Tunisia. Active treatment was indapamide sustained-release 1.5 mg with the addition of perindopril 2-4 mg as required to reach a target blood pressure of less than 150/80 mmHg.
  
  
  RESULTS
  For total mortality, benefits were consistent: men [hazard ratio 0.82, 95% confidence interval (CI) 0.62-1.11], women (hazard ratio 0.77, 95% CI 0.66-0.99), those aged 80-84.9 (hazard ratio 0.76, 95% CI 0.60-0.96), those aged 85 and over (hazard ratio 0.87, 95% CI 0.64-1.20), those with a history of CVD (hazard ratio 0.76, 95% CI 0.48-1.20) and those without (hazard ratio 0.81, 95% CI 0.65-0.99), and similarly across a range of baseline SBPs. The point estimates for cardiovascular mortality, strokes, heart failure and cardiovascular events were all in favour of benefit. In the per-protocol analysis, strokes were reduced by 34% (P = 0.026), total mortality by 28% (P = 0.001), cardiovascular event by 37% (P < 0.001) and heart failure by 72% (P < 0.001).
  
  
  CONCLUSIONS
  In hypertensive patients aged 80 or more, treatment based on indapamide (sustained-release) 1.5 mg showed consistent benefits across pre-specified subgroups including those without established CVD (the majority), supporting the need for treatment even at this advanced age. There were too few aged 90 or over to determine benefit from treatment at extreme age.
authors.affiliation: aImperial College London, Faculty of Medicine, London, UK bMedical University of Milano, Cardiovascular Rehabilitation and Cardiac Disease Unit, Milan, Italy cMater Hospital, Dublin, Ireland dHypertension & Cardiovascular Rehabilitation Unit, Catholic University of Leuven, Belgium eDepartment Hypertension and Diabetology, Meical University of Gdansk, Poland fWhitby Group Practice, Whitby gLondon School of Hygiene and Tropical Medicine, London, UK *All committee members and investigators are listed in the On-line Supplement.
authors.forename: Nigel
authors.initials: N
authors.lastname: Beckett
authors.forename: Ruth
authors.initials: R
authors.lastname: Peters
authors.forename: Gastone
authors.initials: G
authors.lastname: Leonetti
authors.forename: Joe
authors.initials: J
authors.lastname: Duggan
authors.forename: Robert
authors.initials: R
authors.lastname: Fagard
authors.forename: Lut
authors.initials: L
authors.lastname: Thijs
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Narkiewicz
authors.forename: Terry
authors.initials: T
authors.lastname: McCormack
authors.forename: Winston
authors.initials: W
authors.lastname: Banya
authors.forename: Astrid
authors.initials: A
authors.lastname: Fletcher
authors.forename: Christopher
authors.initials: C
authors.lastname: Bulpitt
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D007190:Indapamide / Q000008:administration & dosage; D008297:Male; D020913:Perindopril / Q000008:administration & dosage; D018570:Risk Assessment; D020521:Stroke / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control
chemical_list: D000959:Antihypertensive Agents; D003692:Delayed-Action Preparations; D004338:Drug Combinations; C494243:indapamide, perindopril drug combination; D007190:Indapamide; D020913:Perindopril