Treatment of hypertension in patients 80 years of age or older. Export

@article{citeulike:2759602, 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].).}, address = {Care of the Elderly, Division of Medicine, Imperial College London, United Kingdom.}, author = {Beckett, Nigel S. and Peters, Ruth and Fletcher, Astrid E. and Staessen, Jan A. and Liu, Lisheng and Dumitrascu, Dan and Stoyanovsky, Vassil and Antikainen, Riitta L. and Nikitin, Yuri and Anderson, Craig and Belhani, Alli and Forette, Fran\c{c}oise and Rajkumar, Chakravarthi and Thijs, Lutgarde and Banya, Winston and Bulpitt, Christopher J. and {HYVET Study Group}}, citeulike-article-id = {2759602}, citeulike-linkout-0 = {http://dx.doi.org/10.1056/NEJMoa0801369}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/18378519}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=18378519}, day = {1}, doi = {10.1056/NEJMoa0801369}, issn = {1533-4406}, journal = {The New England journal of medicine}, keywords = {diuretics, hypertension, indapamide}, month = {May}, number = {18}, pages = {1887--1898}, posted-at = {2009-08-14 07:07:35}, priority = {2}, title = {Treatment of hypertension in patients 80 years of age or older.}, url = {http://dx.doi.org/10.1056/NEJMoa0801369}, volume = {358}, year = {2008} }

TY - JOUR ID - citeulike:2759602 L3 - citeulike-article-id:2759602 N2 - 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].). IS - 18 JF - The New England journal of medicine SN - 1533-4406 AD - Care of the Elderly, Division of Medicine, Imperial College London, United Kingdom. EP - 1898 TI - Treatment of hypertension in patients 80 years of age or older. VL - 358 SP - 1887 KW - diuretics KW - hypertension KW - indapamide AU - Beckett, Nigel AU - Peters, Ruth AU - Fletcher, Astrid AU - Staessen, Jan AU - Liu, Lisheng AU - Dumitrascu, Dan AU - Stoyanovsky, Vassil AU - Antikainen, Riitta AU - Nikitin, Yuri AU - Anderson, Craig AU - Belhani, Alli AU - Forette, Françoise AU - Rajkumar, Chakravarthi AU - Thijs, Lutgarde AU - Banya, Winston AU - Bulpitt, Christopher PY - 2008/05/01/ UR - http://dx.doi.org/10.1056/NEJMoa0801369 ER -