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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Given this uncertainty, the Hypertension in the Very Elderly Trial HYVET was commissioned with an open label pilot undertaken to determine hyveg feasibility [ 1112 ].
Retrieved from ” http: Although waist circumference was not reported, hypertensive status was infrequently associated with other features of the metabolic syndrome in the trial population, aside from those subjects who had suffered a prior cardiovascular event [ 17 ].
Treating very elderly hypertensive patients is rewarding: 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 hjvet are prone to hypovolemia and orthostatic syncope, etc. N Engl J Med. It is possible that the difference in stroke rates would have reached statistical significance had the trial not been stopped early.
Thus, the benefit of treatment above 85—90 years of age remains uncertain [ 1819 ]. Subjects were then randomized to one of two treatment arms, the thiazide like diuretic, indapamide sustained release, 1.
Whilst these results strengthen the case for early benefit arising from anti-hypertensive therapy shudy octogenarians, the selective exclusion criteria are questionable.
Main study findings A double-blind placebo-controlled trial with recruitment centres in 13 countries, HYVET prospectively analyzed data from older adults. Thus, no significant difference was observed between the two trial arms HR 0. Br J Clin Pharmacol. 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; A double-blind placebo-controlled trial with recruitment centres in 13 countries, HYVET prospectively analyzed data from older adults.
This treatment regimen was also found to be associated with a large and significant reduction in heart failure, whilst proving particularly efficacious in the management of isolated systolic hypertension. Effects of treatment on morbidity in hypertension.
JNC 8 hypertension guidelinesadapted . This appeared to detect small differences between the two trial arms, in favour of treatment. Allowing for all fractures, regardless of whether they were incident, validated fractures or not, resulted in an adjusted HR of 0. Thus, social and economic status were not adequately controlled for and reverse causality could not be excluded.
Author information Article notes Copyright and License information Disclaimer. However, those hyvey had reached either primary or secondary end points during the main trial apart from myocardial infarction, heart failure and skeletal fracture were excluded. Immediate and late benefits of treating very elderly people with hypertension: In addition, it was notable that four centres closed in the first year due to data quality issues [ 13 ].
Medical Research Council trial of treatment of hypertension in older adults: Whilst each additional GDS point at baseline also increased these risks, the study was not designed to evaluate this yyvet. Support Center Support Center. Hypertension — treated and untreated. At 2 years there were no significant changes in serum potassium, uric acid, glucose and creatinine between the trial arms [ 13 ].
Some have interpreted HYVET as a negative study, since the P value for the primary outcome of stroke did not reach statistical significance. Once again, the relative well being of the trial participants limits the potential applicability of these data to the general population.
Views Read View source View history. Early trials in the field of hypertension focused on adults in their fifties and sixties. Given the log linear relationship between systolic blood pressure and clinical outcomes, hhvet mortality and morbidity benefits seen in the trial might be a feature hhvet systolic BP control, particularly in ISH, as opposed to achieved systolic and diastolic blood pressure.
Those on antihypertensives at baseline had their medications stopped prior to placebo run-in. Five-year findings of the Hypertension Detection and Follow-up Program: Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. 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.
Results of the pilot study for the hypertension in the very elderly trial. Secondary outcomes included rates of fatal stroke, all-cause mortality, and CV events. Published online Aug HYVET also has a number of methodological issues, namely the protocol amendment which provided for the inclusion of subjects with ISH and the variable methods for measuring blood pressure.
Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension.
The optimal target BP among very elderly patients has yet to be defined. In fact, serious adverse events SAEs were observed post-randomization in the placebo group. More importantly, the early evidence of mortality benefit resulted in a relatively short duration of follow-up median 1. National Center for Biotechnology InformationU. Equally, at the time of the second interim analysis July the relative risk etudy all stroke fatal and non-fatal amongst those receiving active treatment was 0.
This enhanced recruitment rates and led to the inclusion of subjects with isolated systolic hypertension ISH. This hypothesis, that indapamide a thiazide-like diuretic reduces urinary calcium excretion and as a result may reduce fracture rates, was tested in a sub-study.