Keywords: elderly, hypertension, HYVET, older adults, treatment In the pilot study, subjects aged over 80 years, with a sustained blood. Kardiol Pol. Jul;66(7); discussion [HYVET study – treatment for hypertension]. [Article in Polish]. Zalewska J(1). Author information. “In the main HYVET study, we aimed to resolve persistent areas of clinical uncertainty about the relative benefits and risks of antihypertensive.
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Whilst these results strengthen the case for early benefit arising from anti-hypertensive therapy in octogenarians, the selective exclusion criteria are questionable.
The Hypertension in the Very Elderly Trial – latest data
Received Apr 30; Accepted Aug Whilst each additional GDS point at baseline also increased these risks, the study was not designed to evaluate this association. Stepwise treatment consisted of a diuretic indapamide sustained release 1.
Abstract Early trials in the field of hypertension focused on adults in their fifties and sixties. In addition, it was notable that four centres closed in the first year due to data quality issues [ 13 ].
This review provides an overview of the Hypertension in the Very Elderly Trial whilst also discursively evaluating the latest data. Treatment of hypertension in patients 80 years of age or older. Mortality by race-sex and age. Given the log linear relationship between systolic blood pressure and clinical outcomes, the mortality and morbidity benefits seen in the trial might be a feature of systolic BP control, particularly in ISH, as opposed to achieved systolic and diastolic blood pressure.
Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Beckett NS, et al.
[HYVET study – treatment for hypertension].
The New England Journal of Medicine. More importantly, the early evidence of mortality benefit resulted in a relatively short duration of follow-up median 1.
In common with many other clinical trials in older people, the inclusion criteria also required that subjects be in relatively good physical and mental health individuals with dementia and those resident in nursing homes were excludedquestioning the applicability of the trial outcomes to the real life setting [ 1316 ].
Once again, the relative well being of the trial participants limits the potential applicability of these data to the general population.
Five-year findings of the hypertension Detection and Follow-up Program: Usable articles Nephrology Cardiology Geriatrics. More recently, additional data from this cohort has been published suggesting that appropriate anti-hypertensive therapy may lead to a reduction in incident cognitive impairment and fractures, whilst a 1 year open label extension of the main study confirmed many of the original trial findings.
[HYVET study – treatment for hypertension].
N Engl J Med. Five-year findings of the Hypertension Detection and Follow-up Program: Although the model requires further validation, it suggests that cognitive change in those aged over 80 years is small, depends on baseline cognitive function and the relative efficacy of anti-hypertensive treatment [ 25 ].
Main study findings A double-blind placebo-controlled trial with recruitment centres in 13 countries, HYVET prospectively analyzed data from older adults. At 2 years there were no significant changes in serum potassium, uric acid, glucose and creatinine between the trial arms [ 13 ].
HYVET – Wiki Journal Club
Given this uncertainty, the Hypertension in the Very Elderly Trial HYVET was commissioned with an open label pilot undertaken to determine trial feasibility [ 1112 ]. This page was last modified on 11 Januaryat Moreover, active treatment was well tolerated. Treatment of hypertension in the elderly. Sociodemographic and lifestyle risk factors for incident dementia and cognitive decline in the HYVET.
Initially blood pressures were recorded with either a mercury sphygmomanometer or a validated automated device, but at the end of the trial a validated automated device was used in the majority stduy centres [ 13 ].
Whilst a statistically significant reduction in congestive cardiac failure was also observed unadjusted HR 0.
Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Subjects were then randomized to one of two treatment arms, the thiazide like diuretic, indapamide sustained release, 1.
Yet the authors of the meta-analysis noted that a single, randomized controlled trial demonstrating no benefit from anti-hypertensive therapy, in this cohort, would negate the apparent benefits seen across their meta-analysis [ 11 ]. Views Read View source View history. In that vein, some have expressed significant concerns with over-treatment of hypertension in the elderly, citing the risks of polypharmacy and the fact that elderly patients are prone to hypovolemia and orthostatic syncope, etc.
When analyzing the 90 incident, validated fractures 38 in the active group; 52 in the placebo group and adjusting for baseline risk factors, a HR of 0. Some have interpreted HYVET as a negative study, since the P value for the primary outcome of stroke did not reach statistical significance. As a result, it remains unclear whether such benefits persist or diminish over a longer time course and although the inclusion criteria allowed for the enrolment of patients aged between 80 and years, most were 80 to 85 years old mean age; Equally, at the time of the second interim analysis July the relative risk of all stroke fatal and non-fatal amongst those receiving active treatment was 0.
Among very elderly patients with hypertension, does active treatment with antihypertensives reduce the rate of fatal or nonfatal stroke when compared with placebo? The initial inclusion criteria demanded both systolic and diastolic hypertension SDH mean systolic BP — mmHg; mean diastolic BP 90— mmHgoff treatment, during a 2 month run in period. The s saw publication of landmark data demonstrating the benefits of anti-hypertensive therapy [ 1 — 3 ].
The investigators also observed a non-significant reduction in the primary outcome measure, stroke, byvet hazard ratio HR 0. Again, differences were seen for all-cause mortality 47 deaths; HR 0. Reduction in mortality of persons with high blood pressure, including mild hypertension.