Baseline characteristics of participants in the Hypertension in the Very Elderly Trial (HYVET)

Abstract

The Hypertension in the Very Elderly Trial (HYVET) is a randomized double-blind trial of active antihypertensive treatment (indapamide 1.5 mg sustained release +/-2-4 mg perindopril) vs placebo in participants over the age of 80 years with a systolic blood pressure (SBP) of 160-199 mmHg during a placebo run-in period plus a diastolic blood pressure (DBP) of<110 mmHg. The trial has completed with 3845 subjects randomized and we report the baseline characteristics. The participants were a healthy group. The numbers smoking, drinking alcohol and having previous cardiovascular events were low, and their hypertensive status was not usually associated with the metabolic syndrome; 1.0% of the whole group had a total cholesterol over 8.0 mmol/l, 1.1% a blood sugar over 11.1 mmol/l (irrespective of anti-diabetic treatment) and 1.7% a serum urate over 460 micromol/l (women) and 0.6% over 520 micromol/l (men). A serum creatinine over 150 micromol/l excluded participants from the trial. The gender differences and age comparisons were as expected but the women had higher average total and high-density-lipoprotein-cholesterol blood concentrations. Those with prior cardiovascular disease had an excess of the known cardiovascular risk factors. The baseline characteristics provide a basis for further understanding of the HYVET results, which have been published recently.

The Hypertension in the Very Elderly Trial – latest data

“…The number of subjects who smoked cigarettes (2.2% of females were current smokers and 13.0% of men), drank alcohol (34.5% of men and 6.8% of women) or had experienced a previous cardiovascular event (14.6% of men and 9.9% of women) was low. Although waist circumference was not reported, hypertensive status was infrequently associated with other features of the metabolic syndrome in the trial population, aside from those subjects who had suffered a prior cardiovascular event [17]. More importantly, the early evidence of mortality benefit resulted in a relatively short duration of follow-up (median 1.8 years) [13].…”

Changes in Ankle Brachial Pulse Wave Velocity during a Five-Year Follow-up Period in Older Japanese Adults: Sub-analysis Results of the Health Research Volunteer Study in Japan

“…This relationship explains why hypertension is an important predictor of cardiovascular events and why controlling high blood pressure results in significant reductions in cardiovascular events and mortality (10)(11)(12). However, the effects of aging, hypertension, pharmaceutical intervention and other various factors on arterial stiffness remain to be explored, especially among older adults (13,14). We therefore chose to examine the effects of medication and other factors on arterial stiffness during a five-year cohort study primarily examining the prediction of frailty syndrome development in older Japanese adults.…”

Response to Einhorn and Colleagues

“…Trial participants may not be completely representative of the population actually treated, particularly in older adults . For example, the Hypertension in the Very Elderly Trial, although commendable in many ways, enrolled participants with a substantially more‐favorable risk profile and prognosis than the broader population of older adults with hypertension in the age group it was designed to study (≥80) . Furthermore, as illustrated in Einhorn et al's Table 1, our findings should be viewed as being complementary to randomized controlled trial (RCT) data, because our study represented a different population than the Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial and more specifically examined thiazide‐induced metabolic AEs.…”