Related Experiment Videos

Older age should not be a barrier to the treatment of hypertension

Wilbert S Aronow1

  • 1Division of Cardiology, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, NY 10595, USA. wsaronow@aol.com

Nature Clinical Practice. Cardiovascular Medicine
|July 9, 2008
PubMed

Insights

Treatment for hypertension in elderly patients (80+ years) significantly reduces stroke, mortality, and heart failure. The Hypertension in the Very Elderly Trial (HYVET) demonstrated clear benefits of antihypertensive drug therapy in this population.

Area of Science:

  • Geriatric Medicine
  • Cardiovascular Research
  • Clinical Trials

Background:

  • Controversy exists regarding the efficacy and safety of antihypertensive drug therapy in patients aged 80 years and older.
  • Previous studies have not definitively settled the debate on treating hypertension in the very elderly.

Purpose of the Study:

  • To determine the efficacy and safety of antihypertensive drug therapy in patients aged 80 years and older.
  • To provide evidence-based recommendations for hypertension management in the very elderly population.

Main Methods:

  • A double-blind, randomized, placebo-controlled trial (Hypertension in the Very Elderly Trial - HYVET) was conducted.
  • Participants received indapamide, with perindopril added as needed, or a placebo.
  • Follow-up was conducted over 2 years.

Main Results:

  • Antihypertensive therapy reduced fatal or nonfatal stroke by 30% and fatal stroke by 39%.
  • All-cause mortality decreased by 21%, cardiovascular death by 23%, and heart failure by 64%.
  • The benefits were statistically significant and clinically meaningful.

Conclusions:

  • Antihypertensive drug therapy, including indapamide and perindopril, is efficacious and beneficial in patients aged 80 years and older with hypertension.
  • These findings support the routine treatment of hypertension in the very elderly population.
  • The HYVET trial provides strong evidence to guide clinical practice for this demographic.

Related Concept Videos

Drug Dosing: Geriatric Patients01:15

Drug Dosing: Geriatric Patients

Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
Hypertension I: Introduction01:28

Hypertension I: Introduction

Hypertension is a widespread, long-term medical condition where blood pressure in the arteries remains elevated. It is characterized by systolic blood pressure readings of 130 mm Hg or above or diastolic blood pressure (DBP) readings of 80 mm Hg or higher. Unmanaged hypertension poses significant health risks, making the distinction between primary (or essential) hypertension and secondary hypertension crucial, as their management and implications vary.Primary HypertensionPrimary hypertension,...
Hypertension IV: Drug Therapy and Lifestyle Modifications01:28

Hypertension IV: Drug Therapy and Lifestyle Modifications

Multiple classes of antihypertensive medications are employed in treating hypertension. The most commonly recommended first-line treatments include:Thiazide Diuretics, such as chlorthalidone, increase sodium and water excretion from the body, reducing blood volume and blood pressure.Angiotensin-converting enzyme inhibitors, like lisinopril, block the conversion of angiotensin I to II, a potent vasoconstrictor lowering blood pressure.Angiotensin II Receptor Blockers (ARBs) prevent angiotensin II...
Hypertension and Regulation of Blood Pressure01:18

Hypertension and Regulation of Blood Pressure

Hypertension, the most common cardiovascular disease, is diagnosed through repeated measurements of elevated blood pressure. Its risks, including damage to the kidney, heart, and brain, are directly proportional to blood pressure levels. Starting from 115/75 mm Hg, the risk of cardiovascular disease doubles with each increment of 20/10 mm Hg. The diagnosis relies on blood pressure measurements, not on patient symptoms, as hypertension is often asymptomatic until end-organ damage is imminent or...
Pharmacodynamics in Geriatric Patients: Effects of Age01:27

Pharmacodynamics in Geriatric Patients: Effects of Age

Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...