The reduction in cardiovascular mortality and morbidity was primarily due to a reduction in cerebrovascular mortality and morbidity .
AUTHORS ' CONCLUSIONS Treating healthy adults 60 years or older with moderate to severe systolic and /or diastolic hypertension with antihypertensive drug therapy reduced all-cause mortality , cardiovascular mortality and morbidity , cerebrovascular mortality and morbidity , and coronary heart disease mortality and morbidity .
Most evidence of benefit pertains to a primary prevention population using a thiazide as first-line treatment
BACKGROUND This is the second substantive up date of this review .
It was originally published in 1998 and was previously up date d in 2009 .
Elevated blood pressure ( known as ' hypertension ' ) increases with age - most rapidly over age 60 .
Systolic hypertension is more strongly associated with cardiovascular disease than is diastolic hypertension , and it occurs more commonly in older people .
It is important to know the benefits and harms of antihypertensive treatment for hypertension in this age group , as well as separately for people 60 to 79 years old and people 80 years or older .
The Hypertension in the Very Elderly Trial (HYVET)
Summary The Hypertension in the Very Elderly Trial ( HYVET ) is a multicentre , open , r and omised , controlled trial . The aim of this trial is to investigate the effect of active treatment on stroke incidence in hypertensive patients over the age of 80 years . Secondary end-points include total cardiovascular mortality and morbidity . Entry criteria include a sustained sitting systolic blood pressure of 160 to 219 mm Hg plus a sustained sitting diastolic pressure of 95 to 109 mm Hg . Also required is a st and ing systolic blood pressure of at least 140 mm Hg . Patients must give their informed consent , and be free of congestive heart failure requiring treatment , gout , renal failure or a recent cerebral haemorrhage . Patients are to be r and omised to 3 groups — ( i ) no treatment ; ( ii ) treatment with a diuretic [ bendroflumethiazide ( bendrofluazide ) ] ; or ( iii ) treatment with an angiotensin converting enzyme ( ACE ) inhibitor (lisinopril).Starting dosage for bendroflumethiazide and lisinopril is 2.5 mg/day . In order to achieve goal sitting systolic and diastolic blood pressures ( < 150/80 mm Hg ) , a doubling of the dosage is allowed . Furthermore , slow release diltiazem ( 120 mg/day increasing to 240 mg/day if required ) may be added to the medication of the actively treated groups . These drugs have been chosen as inexpensive and appropriate representatives of their therapeutic classes.700 patients in each group ( a total of 2100 ) will be sufficient to detect a 40 % difference in cerebrovascular events between no treatment and active treatment ( α = 0.01 , 1−β = 0.90 ) . These numbers will also detect a difference in total mortality of 25 % and in cardiovascular mortality of 35%.The pilot phase of the trial has been started with support from the British Heart Foundation . Centres which are interested in taking part should contact C. J. Bulpitt or any of the other authors
The reduction in cardiovascular mortality and morbidity was primarily due to a reduction in cerebrovascular mortality and morbidity .
AUTHORS ' CONCLUSIONS Treating healthy adults 60 years or older with moderate to severe systolic and /or diastolic hypertension with antihypertensive drug therapy reduced all-cause mortality , cardiovascular mortality and morbidity , cerebrovascular mortality and morbidity , and coronary heart disease mortality and morbidity .
Most evidence of benefit pertains to a primary prevention population using a thiazide as first-line treatment
BACKGROUND This is the second substantive up date of this review .
It was originally published in 1998 and was previously up date d in 2009 .
Elevated blood pressure ( known as ' hypertension ' ) increases with age - most rapidly over age 60 .
Systolic hypertension is more strongly associated with cardiovascular disease than is diastolic hypertension , and it occurs more commonly in older people .
It is important to know the benefits and harms of antihypertensive treatment for hypertension in this age group , as well as separately for people 60 to 79 years old and people 80 years or older .