You’re Never Too Old for High Blood Pressure Treatment

Should older folk take antihypertensive drugs? Some authorities say ‘no’, others say ‘yes’. (By ‘older folk’ I mean people older than me, i.e. 80-year-olds.)

Some studies have shown reductions in stroke with treatment, others have noised concerns about increased mortality in older individuals taking antihypertensive medications. The Hypertension in the Very Elderly Trial (HYVET), which was reported in the New England Journal of Medicine, was designed to settle this question.

Investigators in 13 countries randomized over 3,800 participants with systolic hypertension (upper blood pressure above 160 mmHg) aged 80 years or older to receive indapamide (a water pill, 1.5 mg) or placebo, adding perindopril (an ACE inhibitor, 2 mg or 4 mg) or placebo, as necessary, to achieve a target blood pressure of 150/80 mmHg.

The average age of the participants was 84. After 2 years blood pressure was lower in the active-treatment group than in the placebo group by 15.0/6.1 mmHg. This difference was associated with a 30% reduction in fatal or nonfatal stroke, a 39% reduction in deaths from stroke, a 21% reduction in all-cause deaths, a 23% reduction in cardiovascular deaths, and a 64% reduction in heart failure. Moreover, fewer side effects were reported in the treatment group than in the placebo group.

The results were so clear-cut that the trial was halted early. They shop that there’s no good reason why someone over 80 shouldn’t be treated for high blood pressure just as if they were 70 (or 60). In fact, the benefits will far outstrip the risks.