Strokes, Deaths Reduced Among Very Elderly with
Hypertension by ‘Water Pill’
Indapamide, (Lozol) declared “very beneficial” to
those 80 and over
April 4, 2008 - Results of research presented at
the American College of Cardiology’s 57th Annual Scientific Session show
that treatment of high blood pressure based on indapamide sustained
release (SR) 1.5mg is beneficial in very elderly people with high blood
pressure to reduce fatal strokes and cardiovascular events as well as
all-cause mortality.
“Before our study, doctors were unsure about
whether very elderly people with high blood pressure could see the same
benefits from treatment to lower their blood pressure as those we see in
younger people,” said Emeritus Professor Christopher Bulpitt, the lead
investigator on the study from the Care of the Elderly group at Imperial
College London.
“Our results clearly show that many patients aged
80 and over could benefit greatly from treatment. Populations are living
longer and we have growing numbers of people living well into their 80s
and beyond, so this is good news.”
The Hypertension in the Very Elderly (HYVET) Trial
was a randomized double-blind placebo-controlled study involving
patients aged 80 or older. The trial randomized 3,845 patients with a
mean age at baseline of 84±3 years and a mean entry blood pressure of
173/91 ± 9/8 mmHg.
Entry criteria included a systolic blood pressure
of 160-199 mmHg. Active treatment was indapamide (SR) 1.5mg with the
addition of perindopril 2-4 mg, in tablet form once a day as required,
to reach a target blood pressure of 150/80 mmHg. The primary end-point
was all-strokes.
While elevated blood pressure levels are common
among very elderly hypertensive patients, the benefit-to-risk ratio for
treating such patients had not been established. Epidemiological data
suggested decreased mortality with higher blood pressure levels.
About Indapamide
(Lozol)
Indapamide, brand name Lozol, a 'water
pill,' is used to reduce the swelling and fluid retention caused
by heart disease. It also is used to treat high blood pressure.
It causes the kidneys to get rid of unneeded water and salt from
the body into the urine.
Indapamide also is used to treat swelling
and fluid retention caused by various medical conditions other
than heart disease.
Indapamide comes as a tablet to take by
mouth. It usually is taken once a day, in the morning.
Indapamide controls high blood pressure
but does not cure it. Patients should continue to take
indapamide even if they feel well. They should never stop taking
indapamide without talking to their doctor.
Intervention trials had not included sufficient
numbers in the 80-plus age group to clarify this association.
The average follow-up for the HYVET study was just
over two years, by which time 20 percent of the placebo subjects and 48
percent of those taking medication had achieved the target blood
pressure of 150/80 mmHg. In patients followed longer, a greater number
who received active treatment achieved the target blood pressure.
In July 2007, the HYVET steering committee accepted
the recommendations of the independent trial data-monitoring and ethics
committees to stop the trial early. This was based on the results from
the second planned interim analysis that showed a significant reduction
in the primary endpoint and total mortality.
The HYVET study final results showed a 21 percent
(p=0.02) reduction in total mortality rate and a 30 percent reduction in
the rate of all-strokes although the latter did not reach statistical
significance (p=0.06).
A significant reduction of 39 percent (p=0.05) was
observed in the rates of fatal strokes, of 64 percent (p<0.001) in fatal
and non-fatal heart failure, and 34 percent (p<0.001) in cardiovascular
events. The benefits were apparent within the first year of follow-up.
“These results will have important implications for
the generation of future guidelines and mean that very elderly
individuals with sustained systolic blood pressures of 160 mmHg or more
should now be appropriately assessed and treated in accordance with the
new findings,” added Nigel S. Beckett, M.D., the trial coordinator from
the Care of the Elderly group at Imperial College London.
Sponsored by Imperial College London, HYVET was the
largest randomized, controlled trial assessing the benefit-to-risk ratio
of treating hypertensive patients 80 years of age and older.
The results showed that lowering blood pressure of
elderly patients could cut their total mortality by a fifth and their
rate of cardiovascular events by a third. The findings have the
potential to affect the treatment and impact the health outcomes of
millions of individuals.
The HYVET trial results will be simultaneously
published in the New England Journal of Medicine.
Dr. Beckett presented this study, The
Hypertension in the Very Elderly Trial (HYVET): Main Results on
March 31.
Editor’s Notes:
The American College of Cardiology (www.acc.org)
represents the majority of board certified cardiovascular physicians in
the United States. Its mission is to advocate for quality cardiovascular
care through education, research, promotion, development and application
of standards and guidelines- and to influence health care policy. ACC.08
is the largest cardiovascular meeting, bringing together cardiologists
and cardiovascular specialists to share the newest discoveries in
treatment and prevention, while helping the ACC achieve its mission to
address and improve issues in cardiovascular medicine.
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April 4, 2008 - Results of research presented at
the American College of Cardiology’s 57th Annual Scientific Session show
that treatment of high blood pressure based on indapamide sustained
release (SR) 1.5mg is beneficial in very elderly people with high blood
pressure to reduce fatal strokes and cardiovascular events as well as
all-cause mortality.