Immediate and late benefits of treating very elderly people with hypertension: results from active treatment extension to Hypertension in the Very Elderly randomised controlled trial
Identifieur interne : 000801 ( Main/Exploration ); précédent : 000800; suivant : 000802Immediate and late benefits of treating very elderly people with hypertension: results from active treatment extension to Hypertension in the Very Elderly randomised controlled trial
Auteurs : N. Beckett [Royaume-Uni] ; R. Peters [Royaume-Uni] ; J. Tuomilehto [Finlande] ; C. Swift [Royaume-Uni] ; P. Sever [Royaume-Uni] ; J. Potter [Royaume-Uni] ; T. Mccormack [Royaume-Uni] ; F. Forette [France] ; B. Gil-Extremera [Espagne] ; D. Dumitrascu [Roumanie] ; J A Staessen [Pays-Bas] ; L. Thijs [Belgique] ; A. Fletcher [Royaume-Uni] ; C. Bulpitt [Royaume-Uni]Source :
- BMJ [ 0959-8138 ] ; 2012.
Abstract
Objective To assess if very elderly people with hypertension obtain early benefit from antihypertensive treatment. Design One year open label active treatment extension of randomised controlled trial (Hypertension in the Very Elderly Trial (HYVET)). Setting Hospital and general practice based centres mainly in eastern and western Europe, China, and Tunisia. Participants People on double blind treatment at the end of HYVET were eligible to enter the extension. Interventions Participants on active blood pressure lowering treatment continued taking active drug; those on placebo were given active blood pressure lowering treatment. The treatment regimen was as used in the main trial—indapamide SR 1.5 mg (plus perindopril 2-4 mg if required)—with the same target blood pressure of less than 150/80 mm Hg. Main outcome measures The primary outcome was all stroke; other outcomes included total mortality, cardiovascular mortality, and cardiovascular events. Results Of 1882 people eligible for entry to the extension, 1712 (91%) agreed to participate. During the extension period, 1682 patient years were accrued. By six months, the difference in blood pressure between the two groups was 1.2/0.7 mm Hg. Comparing people previously treated with active drug and those previously on placebo, no significant differences were seen for stroke (n=13; hazard ratio 1.92, 95% confidence interval 0.59 to 6.22) or cardiovascular events (n=25; 0.78, 0.36 to 1.72). Differences were seen for total mortality (47 deaths; hazard ratio 0.48, 0.26 to 0.87; P=0.02) and cardiovascular mortality (11 deaths; 0.19, 0.04 to 0.87; P=0.03). Conclusion Very elderly patients with hypertension may gain immediate benefit from treatment. Sustained differences in reductions of total mortality and cardiovascular mortality reinforce the benefits and support the need for early and long term treatment. Trial registration Clinical trials NCT00122811.
Url:
DOI: 10.1136/bmj.d7541
Affiliations:
- Belgique, Espagne, Finlande, France, Pays-Bas, Roumanie, Royaume-Uni
- Angleterre, Grand Londres, Uusimaa
- Helsinki, Londres, Paris
- Université d'Helsinki
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Thijs</name><affiliation wicri:level="1"><country xml:lang="fr">Belgique</country><wicri:regionArea>Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven</wicri:regionArea><wicri:noRegion>Leuven</wicri:noRegion></affiliation></author><author><name sortKey="Fletcher, A" sort="Fletcher, A" uniqKey="Fletcher A" first="A" last="Fletcher">A. Fletcher</name><affiliation wicri:level="3"><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><wicri:orgArea>London School of Hygiene and Tropical Medicine</wicri:orgArea></affiliation></author><author><name sortKey="Bulpitt, C" sort="Bulpitt, C" uniqKey="Bulpitt C" first="C" last="Bulpitt">C. Bulpitt</name><affiliation wicri:level="1"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Medicine, Imperial College London, London SW7 2AZ</wicri:regionArea><wicri:noRegion>London SW7 2AZ</wicri:noRegion></affiliation></author></analytic><monogr></monogr><series><title level="j">BMJ</title><title level="j" type="abbrev">BMJ</title><idno type="ISSN">0959-8138</idno><idno type="eISSN">1468-5833</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2012">2012</date><biblScope unit="volume">344</biblScope></imprint><idno type="ISSN">0959-8138</idno></series><idno type="istex">92AAC341C214F2030693AD80017C91249F98592B</idno><idno type="DOI">10.1136/bmj.d7541</idno><idno type="href">bmj-344-bmj-d7541.pdf</idno><idno type="ArticleID">becn850560</idno><idno type="local">bmj;344/jan04_2/d7541</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0959-8138</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Objective To assess if very elderly people with hypertension obtain early benefit from antihypertensive treatment. Design One year open label active treatment extension of randomised controlled trial (Hypertension in the Very Elderly Trial (HYVET)). Setting Hospital and general practice based centres mainly in eastern and western Europe, China, and Tunisia. Participants People on double blind treatment at the end of HYVET were eligible to enter the extension. Interventions Participants on active blood pressure lowering treatment continued taking active drug; those on placebo were given active blood pressure lowering treatment. The treatment regimen was as used in the main trial—indapamide SR 1.5 mg (plus perindopril 2-4 mg if required)—with the same target blood pressure of less than 150/80 mm Hg. Main outcome measures The primary outcome was all stroke; other outcomes included total mortality, cardiovascular mortality, and cardiovascular events. Results Of 1882 people eligible for entry to the extension, 1712 (91%) agreed to participate. During the extension period, 1682 patient years were accrued. By six months, the difference in blood pressure between the two groups was 1.2/0.7 mm Hg. Comparing people previously treated with active drug and those previously on placebo, no significant differences were seen for stroke (n=13; hazard ratio 1.92, 95% confidence interval 0.59 to 6.22) or cardiovascular events (n=25; 0.78, 0.36 to 1.72). Differences were seen for total mortality (47 deaths; hazard ratio 0.48, 0.26 to 0.87; P=0.02) and cardiovascular mortality (11 deaths; 0.19, 0.04 to 0.87; P=0.03). Conclusion Very elderly patients with hypertension may gain immediate benefit from treatment. Sustained differences in reductions of total mortality and cardiovascular mortality reinforce the benefits and support the need for early and long term treatment. Trial registration Clinical trials NCT00122811.</div></front></TEI><affiliations><list><country><li>Belgique</li><li>Espagne</li><li>Finlande</li><li>France</li><li>Pays-Bas</li><li>Roumanie</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li><li>Uusimaa</li></region><settlement><li>Helsinki</li><li>Londres</li><li>Paris</li></settlement><orgName><li>Université d'Helsinki</li></orgName></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="Beckett, N" sort="Beckett, N" uniqKey="Beckett N" first="N" last="Beckett">N. Beckett</name></noRegion><name sortKey="Beckett, N" sort="Beckett, N" uniqKey="Beckett N" first="N" last="Beckett">N. Beckett</name><name sortKey="Bulpitt, C" sort="Bulpitt, C" uniqKey="Bulpitt C" first="C" last="Bulpitt">C. Bulpitt</name><name sortKey="Fletcher, A" sort="Fletcher, A" uniqKey="Fletcher A" first="A" last="Fletcher">A. Fletcher</name><name sortKey="Mccormack, T" sort="Mccormack, T" uniqKey="Mccormack T" first="T" last="Mccormack">T. Mccormack</name><name sortKey="Peters, R" sort="Peters, R" uniqKey="Peters R" first="R" last="Peters">R. Peters</name><name sortKey="Potter, J" sort="Potter, J" uniqKey="Potter J" first="J" last="Potter">J. Potter</name><name sortKey="Sever, P" sort="Sever, P" uniqKey="Sever P" first="P" last="Sever">P. Sever</name><name sortKey="Swift, C" sort="Swift, C" uniqKey="Swift C" first="C" last="Swift">C. Swift</name></country><country name="Finlande"><region name="Uusimaa"><name sortKey="Tuomilehto, J" sort="Tuomilehto, J" uniqKey="Tuomilehto J" first="J" last="Tuomilehto">J. Tuomilehto</name></region><name sortKey="Tuomilehto, J" sort="Tuomilehto, J" uniqKey="Tuomilehto J" first="J" last="Tuomilehto">J. Tuomilehto</name></country><country name="France"><noRegion><name sortKey="Forette, F" sort="Forette, F" uniqKey="Forette F" first="F" last="Forette">F. Forette</name></noRegion></country><country name="Espagne"><noRegion><name sortKey="Gil Extremera, B" sort="Gil Extremera, B" uniqKey="Gil Extremera B" first="B" last="Gil-Extremera">B. Gil-Extremera</name></noRegion></country><country name="Roumanie"><noRegion><name sortKey="Dumitrascu, D" sort="Dumitrascu, D" uniqKey="Dumitrascu D" first="D" last="Dumitrascu">D. Dumitrascu</name></noRegion></country><country name="Pays-Bas"><noRegion><name sortKey="Staessen, J A" sort="Staessen, J A" uniqKey="Staessen J" first="J A" last="Staessen">J A Staessen</name></noRegion></country><country name="Belgique"><noRegion><name sortKey="Thijs, L" sort="Thijs, L" uniqKey="Thijs L" first="L" last="Thijs">L. Thijs</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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