Treating High Blood Pressure in Elderly May Reduce Risk of Death From Any Cause

Your 80-year-old patient has high blood pressure. Should you treat the condition in someone that old? If the patient isn't frail, a study recently published in the New England Journal of Medicine suggests that maybe you should.

"Treatment of Hypertension in Patients 80 Years of Age or Older" reports on the Hypertension in the Very Elderly Trial, or HYVET, which involved 3,845 patients with hypertension from Europe, China, Australasia and Tunisia.

The study authors note that elevated blood pressure is common in individuals ages 80 and older, "a group constituting the fastest-growing segment of the general population." However, results from a previous HYVET study suggest that treatment for hypertension in this age population "was associated with a reduction in stroke but also a possible increase in death from any cause, such that for each stroke prevented, there was one death from a cause other than stroke." Therefore, the intent of this HYVET study was to resolve uncertainty about the relative benefits and risks of treatment for hypertension in individuals 80 years of age and older.

Patients entering the HYVET study had a sustained systolic blood pressure of 160 mm Hg or higher. Of the 3,845 patients who met that and other criteria for study entry (e.g., absence of accelerated or secondary hypertension, no history of hemorrhagic stroke in the previous six months, absence of heart failure requiring antihypertensive treatment, no ongoing nursing care requirement) 1,933 were randomly assigned to the active treatment group; 1,912 were randomly assigned to the placebo group. After a two-month run-in period, patients in the active treatment group received the diuretic indapamide (sustained release, 1.5 mg), with the ACE inhibitor perindopril (2 mg or 4 mg) added if necessary to achieve the target blood pressure of 150/80 mm Hg.

The study produced what the authors describe as a "new and unexpected result" -- the reduction in the risk of death from any cause with active treatment for hypertension. This makes HYVET "one of the few individual studies of hypertension showing benefits of blood-pressure reduction on mortality," they write.

Researchers found that there was a 21 percent reduction in death rates from any cause in the group being actively treated for hypertension. "The rate of fatal stroke was reduced by 39 percent. … The rate of death from cardiovascular causes was reduced by 23 percent," according to the study. In addition, the rate of any cardiovascular event was reduced by 34 percent in the treatment group.

HYVET results also support a target blood pressure of 150/80 mm Hg in patients receiving treatment, the authors contend, noting that this target was reached in nearly 50 percent of treated patients in HYVET after two years. "Whether further reduction is beneficial still needs to be established," the study authors write.

The authors caution against extrapolating HYVET results to elderly patients who are frail because patients in HYVET generally were healthier than those in the general population.