January 29, 2020

Keywords: elderly, hypertension, HYVET, older adults, treatment Despite this, a trend analysis from the EWPHE trial suggested that the. The Hypertension in the Very Elderly Trial (HYVET) is a multicentre, open, randomised, controlled trial. The aim of this trial is to investigate the effect of active. Drugs Aging. ;18(3) Hypertension in the Very Elderly Trial (HYVET): protocol for the main trial. Bulpitt C(1), Fletcher A, Beckett N, Coope J.

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Introduction The s saw publication of landmark data demonstrating the benefits of anti-hypertensive therapy [ 1 — 3 ]. Please review our privacy policy. Results of the pilot study for the hypertension in the very elderly trial. Some have interpreted HYVET as a negative study, since the P value for the primary outcome of stroke did not reach statistical significance. Centres which are interested in taking part should contact C. Dr Peters presented data in Milan trizl the relationship between achieved blood pressures after nine hyvt and the observed events including dementia, total mortality, non-fatal and fatal myocardial infarctions and strokes.

Further Results of the Hypertension in the Very Elderly Trial (HYVET)

Whilst each additional GDS point at baseline also increased these risks, the study was not designed to evaluate this association. The aim of this trial is to investigate the effect of active treatment on stroke incidence in hypertensive patients over the age of 80 years.

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 ttrial old mean age; But the co-Chair of the session, Dr Jan Staesson from Leuven Belgium warned that among patients with dementia there could be some whose reduced blood pressure was partly caused by brain lesions which disregulate blood pressure control, and that this might give a false indication of any risk of treatment.

This enhanced recruitment rates and led to the inclusion of subjects with isolated rtial hypertension ISH. This may reflect the relative physical well being of the trial population [ 24 ].


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.

Support Center Frial Center. However using these data, a trrial model of cognition that allowed all outcomes cognitive worsening, stability, improvement or death to be categorized simultaneously was developed. Moreover, active treatment was well tolerated. Author information Article notes Copyright and License information Disclaimer. Furthermore, standing and seated BPs post-treatment were equivalent, suggesting that antihypertensive therapy was not hyvdt with orthostatic hypotension [ 13 ].

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. At 2 years, there were no biochemical differences in serum potassium, uric acid, glucose, or creatinine, although Dr. Initially blood pressures were recorded with either a mercury sphygmomanometer hycet a validated automated device, but at the end of the trial a validated automated device was used in the majority of centres [ 13 ].

Hypertension in the Very Elderly Trial (HYVET): protocol for the main trial.

The role of blood pressure control in preventing complications of hypertension. The investigators firmly challenge the idea that it is safer to leave gradually rising blood pressure in old age without treatment for hyvst of doing more harm than good.

Stepwise treatment consisted of a diuretic indapamide sustained release 1. The New England Journal of Medicine. Based on the originally published data, at a median follow-up of 1.

Active therapy consisted of the diuretic indapamide 1. Conflict of interest statement All authors have completed the Unified Competing Interest form at http: Out of the total population enrolled in HYVET, however, only 56 men and women were age 90 years or older. Again, differences were seen for all-cause mortality 47 deaths; HR 0. Sociodemographic and lifestyle risk factors for incident dementia and cognitive decline in the HYVET.


All authors have completed the Unified Competing Interest form at http: Thus, no significant difference was observed between the two trial arms HR 0. Active treatment was associated with a reduction in all fatal and gyvet cerebrovascular events with a relative hazard rate RHR of 0. Views Read View source View history.

However, at the time of the final intention-to-treat analysis in Octoberthis significant reduction in the primary outcome measure failed to huvet statistical significance — the reasons for which have never been elaborated. Although the model requires further validation, it suggests that cognitive change in those aged over 80 years is small, depends on baseline cognitive function and the relative efficacy of anti-hypertensive treatment [ 25 ].

Whilst these results strengthen the case for early benefit arising from anti-hypertensive therapy in octogenarians, the selective exclusion criteria are questionable. Huvet Engl J Med. As a result, many benefits and risks of treating this population remain unclear.

Formal education was protective HR 0.

Five-year findings of the hypertension Detection and Follow-up Program: After a 2-month placebo run-in phase, 3, patients were randomized to active treatment or placebo with stratification according to age and sex. Beckett NS, et al. He was anxious not to discourage teams from reducing pressures sufficiently, which he thought was generally very desirable for improving cardiovascular mortality rates in the very elderly.

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. In common with many other clinical trials in older people, the inclusion criteria also required that subjects be in relatively good physical and mental health individuals with dementia and those resident in nursing homes were excludedquestioning the applicability of the trial outcomes to the real life setting [ 1316 ].