Related Experiment Videos

Blood pressure control in the Hypertension in the Very Elderly Trial (HYVET)

C J Bulpitt1, N S Beckett, R Peters

  • 1Imperial College London, Hammersmith Campus, Care of the Elderly, London, UK.

Journal of Human Hypertension
|March 11, 2011
PubMed

Insights

Blood pressure control was achieved in over 70% of elderly patients with isolated systolic hypertension (ISH) using a stepped treatment regimen. This regimen significantly reduced strokes, mortality, and heart failure in the elderly population.

Area of Science:

  • Gerontology
  • Cardiovascular Medicine
  • Clinical Pharmacology

Background:

  • Hypertension is a prevalent condition in the elderly, increasing the risk of cardiovascular events.
  • Effective blood pressure control in individuals over 80 years old is crucial but challenging.
  • The Hypertension in the Very Elderly Trial investigated treatment strategies for this demographic.

Purpose of the Study:

  • To evaluate blood pressure control in elderly hypertensive patients using a three-step treatment regimen.
  • To compare treatment efficacy between patients with combined systolic and diastolic hypertension (SDH) and isolated systolic hypertension (ISH).
  • To assess the impact of treatment titration on blood pressure control and clinical outcomes.

Main Methods:

  • A placebo-controlled trial involving hypertensive participants aged over 80 years.
  • Treatment involved three steps: indapamide, indapamide plus perindopril 2mg, and indapamide plus perindopril 4mg.
  • Blood pressure control was assessed at 2 years, distinguishing between SDH and ISH participants.

Main Results:

  • Active treatment lowered blood pressure significantly more than placebo in both SDH and ISH groups.
  • By 2 years, 62% of SDH and 71% of ISH participants achieved goal systolic blood pressure.
  • Blood pressure control was better in ISH than SDH patients, with incremental perindopril doses improving control.
  • The treatment regimen led to a 30% reduction in strokes, 21% reduction in total mortality, and 64% reduction in heart failure.

Conclusions:

  • A stepped treatment regimen including indapamide and perindopril is effective for blood pressure control in very elderly hypertensive patients.
  • Isolated systolic hypertension showed better blood pressure control compared to combined systolic and diastolic hypertension.
  • The observed reductions in cardiovascular events and mortality exceeded predictions, highlighting the benefits of treating hypertension in the very elderly.

Related Concept Videos

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...
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 V: Nursing Management01:23

Hypertension V: Nursing Management

The nursing management of hypertension involves accurately assessing symptoms, making a comprehensive nursing diagnosis, collaborating with patients to set goals, and implementing targeted interventions to mitigate the condition's impact and improve patient well-being.Comprehensive AssessmentThe initial step in nursing care for hypertension involves a thorough patient assessment. It includes evaluating symptoms such as headaches, dizziness, blurred vision, and previous hypertension episodes.
Hypertension II: Pathophysiology01:29

Hypertension II: Pathophysiology

Hypertension is a chronic condition in which the blood's force against artery walls is excessively high, posing risks such as heart disease. The condition's underlying mechanisms involve complex interactions among the cardiovascular, kidney, and autonomic nervous systems.Renin-Angiotensin-Aldosterone System (RAAS): This system significantly influences blood pressure regulation. When blood pressure decreases, the kidneys secrete renin. This enzyme transforms angiotensinogen, a plasma protein,...
Hypertension III: Clinical Manifestations and Diagnostic Studies01:30

Hypertension III: Clinical Manifestations and Diagnostic Studies

Hypertension is asymptomatic and also referred to as the "silent killer" until it progresses to a severe stage or causes target organ disease. Patients may experience symptoms stemming from the strain on blood vessels and tissues in various organs or the heart's increased workload.Physical exams might show no abnormalities other than high blood pressure. Signs of vascular damage, when present, correspond to the organs supplied by the affected vessels, leading to target organ damage. For...
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,...