Treatment of very elderly hypertensives significantly reduces total mortality and the risk of death from stroke. Results of the HYVET trial

Until recently, it was not known whether treatment of hypertension in the very elderly had any beneficial effects. The Hypertension in the Very Elderly Trial (HYVET) is the first prospective, double-blind trial assessing the efficacy of anti-hypertensive therapy in this age group (80 years and older). Overall, 3,845 patients with a mean age of 83.6 years were randomized either to a group receiving active therapy or one receiving placebo. The mean sitting blood pressure prior to therapy initiation was 173.0/90.8 mmHg. Active therapy included indapamide SR at a dose of 1.5 mg. Perindopril at doses of 2 mg or 4 mg could be added to active therapy in cases where the target blood pressure levels of < 150/< 80 mmHg had not been achieved. Two years after the trial, the mean sitting blood pressure in the active-treatment group was 15.0/6.1 mmHg lower compared with that of the placebo group. The target BP levels of < 150/< 80 mmHg were achieved in almost 50% of patients. HYVET was terminated prematurely for ethical reasons by an independent data monitoring committee after a median duration of therapy of 1.8 years on grounds of a significant difference in total mortality and in the incidence of fatal stroke in favor of the active-treatment group. Total mortality decreased significantly by 21% (p = 0.02), the incidence of fatal stroke by 39% (p = 0.045), and the incidence of heart failure by 64% (p < 0.001). Treatment was tolerated very well, and the incidence of side effects was lower compared with the placebo group. HYVET has furnished crucial evidence that indapamide (sustained-release)-based treatment of hypertension in the very old, with perindopril as add-on therapy in over 70% of patients, has an appreciably beneficial effect in the very old hypertensives and results in a reduced risk of all-cause death, a decrease in fatal stroke, and a decreased incidence of heart failure.