title: Antihypertensive treatment decreases arterial stiffness at night but not during the day. Results from the Hypertension in the Very Elderly Trial.
abstract: The main Hypertension in the Very Elderly Trial (HYVET) demonstrated a very marked reduction in cardiovascular events by treating hypertensive participants 80 years or older with a low dose, sustained release prescription of indapamide (indapamide SR, 1.5 mg) to which was added a low dose of an angiotensin converting enzyme inhibitor in two-thirds of cases (perindopril 2-4 mg). This report from the ambulatory blood pressure sub-study investigates whether changes in arterial stiffness and ambulatory blood pressure (BP) could both explain the benefits observed in the main trial. A total of 139 participants were randomized to placebo [67] and to active treatment [72] and had both day and night observations of BP and arterial stiffness as determined from the Q wave Korotkoff diastolic (QKD) interval. The QKD interval was 5.6 ms longer (p = 0.017) in the actively treated group at night than in the placebo group. This was not true for the more numerous daytime readings so that 24-h results were similar in the two groups. The QKD interval remained longer at night in the actively treated group even when adjusted for systolic pressure, heart rate and height. The reduced arterial stiffness at night may partly explain the marked benefits observed in the main trial.
authors.affiliation: a Department of Medicine , Imperial College London , London , UK.|b Department of Medicine, Brighton and Sussex Medical School , Brighton , UK.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Bulpitt
authors.affiliation: b Department of Medicine, Brighton and Sussex Medical School , Brighton , UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Webb
authors.affiliation: a Department of Medicine , Imperial College London , London , UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Beckett
authors.affiliation: a Department of Medicine , Imperial College London , London , UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Peters
authors.affiliation: d Department of Mathematics, University of Brighton , Brighton , UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cheek
authors.affiliation: e Department of Neurology, The George Institute for Global Health , Sydney , Australia.
authors.forename: Craig
authors.initials: C
authors.lastname: Anderson
authors.affiliation: g Division of Medicine Care of the Elderly Oulu City Hospital and Institute of Health Sciences (Geriatrics), Oulu University , Oulu , Finland.
authors.forename: Riitta
authors.initials: R
authors.lastname: Antikainen
authors.affiliation: f Department of Medicine, University of Leuven , Leuven , Belgium.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
authors.affiliation: b Department of Medicine, Brighton and Sussex Medical School , Brighton , UK.|c Department of Elderly Medicine, Brighton and Sussex University Hospital , Brighton, UK.
authors.forename: Chakravarthi
authors.initials: C
authors.lastname: Rajkumar
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D007190:Indapamide / Q000008:administration & dosage*; D059289:Vascular Stiffness / Q000187:drug effects*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D007190:Indapamide
keywords: HYVET; Hypertension in the very elderly; QKD; ambulatory blood pressure; arterial compliance; vascular stiffness