X-Message-Number: 30670
Date: Wed, 2 Apr 2008 20:16:39 -0800 (PST)
From: 
Subject: Breakthrough in life extension for the elderly

[A 21% decrease in the death rate in 80 year olds is not going to increase
life expectancy by very much. However, at least this is a proof in
principle that life extension is a concept that has validity at all ages.]

Published at www.nejm.org March 31, 2008 (10.1056/NEJMoa0801369)

Treatment of Hypertension in Patients 80 Years of Age or Older

Nigel S. Beckett, M.B., Ch.B., Ruth Peters, Ph.D., Astrid E. Fletcher,
Ph.D., Jan A. Staessen, M.D., Ph.D., Lisheng Liu, M.D., Dan Dumitrascu,
M.D., Vassil Stoyanovsky, M.D., Riitta L. Antikainen, M.D., Ph.D., Yuri
Nikitin, M.D., Craig Anderson, M.D., Ph.D., Alli Belhani, M.D., Fran oise
Forette, M.D., Chakravarthi Rajkumar, M.D., Ph.D., Lutgarde Thijs, M.Sc.,
Winston Banya, M.Sc., Christopher J. Bulpitt, M.D., for the HYVET Study
Group

ABSTRACT

Background Whether the treatment of patients with hypertension who are 80
years of age or older is beneficial is unclear. It has been suggested
that antihypertensive therapy may reduce the risk of stroke, despite
possibly increasing the risk of death.

Methods We randomly assigned 3845 patients from Europe, China,
Australasia, and Tunisia who were 80 years of age or older and had a
sustained systolic blood pressure of 160 mm Hg or more to receive either
the diuretic indapamide (sustained release, 1.5 mg) or matching
placebo. The angiotensin-converting-enzyme inhibitor perindopril (2 or 4
mg), or matching placebo, was added if necessary to achieve the target
blood pressure of 150/80 mm Hg. The primary end point was fatal or
nonfatal stroke.

Results The active-treatment group (1933 patients) and the placebo group
(1912 patients) were well matched (mean age, 83.6 years; mean blood
pressure while sitting, 173.0/90.8 mm Hg); 11.8% had a history of
cardiovascular disease. Median follow-up was 1.8 years. At 2 years, the
mean blood pressure while sitting was 15.0/6.1 mm Hg lower in the
active-treatment group than in the placebo group. In an
intention-to-treat analysis, active treatment was associated with a 30%
reduction in the rate of fatal or nonfatal stroke (95% confidence
interval [CI], -1 to 51; P=0.06), a 39% reduction in the
rate of death from stroke (95% CI, 1 to 62; P=0.05), a 21% reduction in
the rate of death from any cause (95% CI, 4 to 35; P=0.02), a 23%
reduction in the rate of death from cardiovascular causes (95% CI, -1 to
40; P=0.06), and a 64% reduction in the rate of heart failure (95% CI, 42
to 78; P<0.001). Fewer serious adverse events were reported in the
active-treatment group (358, vs. 448 in the placebo group; P=0.001).

Conclusions The results provide evidence that antihypertensive treatment
with indapamide (sustained release), with or without perindopril, in
persons 80 years of age or older is beneficial. (ClinicalTrials.gov
number, NCT00122811 [ClinicalTrials.gov] .)

Source Information

>From Imperial College London (N.S.B., R.P., R.L.A., W.B., C.J.B.) and
the London School of Hygiene and Tropical Medicine (A.E.F.) - both in
London; the University of Leuven, Leuven, Belgium (J.A.S., L.T.); the
Beijing Hypertension League Institute, Beijing (L.L.); Spitalul Judetean
Cluj, Clinica Medical 2, Cluj, Romania (D.D.); the National Transport
Multi-Profile Hospital, Sofia, Bulgaria (V.S.); the University of Oulu,
Oulu, Finland (R.L.A.); the State Scientific Research Institute of
Internal Medicine, Novosibirsk, Russia (Y.N.); the George Institute for
International Health, Sydney (C.A.); L'Etablissement Public de Sant 
Charles Nicolle, Service de Cardiologie, Tunis, Tunisia (A.B.); H pital
Broca, University Paris V, Paris (F.F.); and the Brighton and Sussex
Medical School, Brighton, United Kingdom (C.R.).

This article (10.1056/NEJMoa0801369) was published at www.nejm.org on
March 31, 2008. It will appear in the May 1 issue of the Journal.

Address reprint requests to Dr. Beckett at Care of the Elderly, Division
of Medicine, Imperial College London, Du Cane Rd., London W12 ONN, United
Kingdom.

Full Text of this Article>

http://content.nejm.org/cgi/reprint/NEJMoa0801369.pdf?resourcetype=HWCIT

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