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Treatment of hypertension in patients 80 years of age or older

journal contribution
posted on 2023-06-07, 16:09 authored by Nigel S Beckett, Ruth Peters, Astrid E Fletcher, Jan A Staessen, Lisheng Liu, Dan Dumitrascu, Vassil Stoyanovsky, Riitta L Antikainen, Yuri Nikitin, Craig Anderson, Alli Belhani, Francoise Forette, Chakravarthi RajkumarChakravarthi Rajkumar, Lutgarde Thijs, Winston Banya, Christopher J Bulpitt
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.

History

Publication status

  • Published

Journal

New England Journal of Medicine

ISSN

1533-4406

Publisher

Massachusetts Medical Society

Issue

18

Volume

358

Page range

1887-1898

Department affiliated with

  • Clinical and Experimental Medicine Publications

Notes

This is one of the top 4 publications for Chakravarthi Rajkumar.

Full text available

  • No

Peer reviewed?

  • Yes

Legacy Posted Date

2011-08-24

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