A new study released Monday suggests that treating the elderly for hypertension can reduce their risk of heart disease, stroke and even death.
According to the study, researchers had suspected that giving hypertension medication to the elderly would decrease the risk of stroke but increase the risk of death.
However, the opposite turned out to be true.
More than 3,800 people who were over age 80 and had blood pressure measured at 160/80 or higher were included in the study. About half of the subjects were given indapamide to reduce their blood pressure to about 150/80, and the rest were given a placebo.
For those in the study who were given the medication, there was a:
- 64 per cent reduction in the rate of heart failure.
- 30 per cent reduction in the rate of stroke.
- 39 per cent reduction in the rate of death from stroke.
- 21 per cent reduction in the rate of death from any cause
- 23 per cent reduction in the rate of death from cardiovascular causes.
According to the Heart & Stroke Foundation, one in five Canadians has hypertension, which is another way of saying high blood pressure. It is a primary risk factor for stroke and heart disease.
Nigel S. Beckett was the study's lead author. The research was led by the Department of Care of the Elderly at Imperial College, London, along with a consortium of organizations throughout Europe, China, Australasia and North Africa.
The study will appear in the online edition of The New England Journal of Medicine on March 31, and in the May 1 print edition.
Abstract
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. (ClinicalTrials.gov number, NCT00122811 [ClinicalTrials.gov] .)
