Hypertension Treatment In Elderly Patients Over 80 Years Of Age Reduces Mortality By 21%
April 03, 2017
The use of antihypertensive treatment in people over 80 years of age has shown to reduce mortality for all causes by 21% which provides the first solid evidence on the usefulness of the pharmacological treatment of hypertension among the elderly. This has been shown by the HYVET trial whose results are being discussed at the XVI World Congress of Cardiology taking place in Buenos Aires from the 18th to the 21st of May, 2008 with the attendance of more than 15,000 professionals coming from over 100 countries.
"The HYVET trial conducted in patients over 80 showed that the pharmacological treatment of this population significantly decreased total mortality and cardiovascular mortality," stated Dr Guillermo Fabregues, vice-president of the Argentine Cardiology Foundation, the community branch of the Argentine Society of Cardiology (SAC). This is a very important trial since until it was published, the evidence available said that treating elderly patients over 80 years of age with anti hypertension drugs reduced the rate of stroke but increased total mortality; this new trial has conclusively shown the benefit of treating these patients."
HYVET (Hypertension in the Very Elderly) is the largest clinical trial to date in patients with hypertension over 80 years of age. The trial included 3,854 patients who received a combination of Indapamide and Perindopril. The investigators decided to stop the study early due to the conclusive results which provided sound clinical evidence supporting the most recent guidelines for the treatment of hypertension.
Dr Alberto Zanchetti, Italian cardiologist of the Center of Clinical Physiology and Hypertension of the University of Milan who is participating at the Congress explained that "The European Hypertension Guidelines published in June, 2007, firmly supported hypertension treatment for the elderly, but recognized that the benefits of this treatment had not yet been proven in patients over 80 years of age. Now the HYVET Trial results will allow the guidelines to do away with this limitation".Dr Zanchetti stated that the results of three other relevant clinical trials on hypertension will be discussed within the frame of the XVI World Congress of Cardiology:
- The ADVANCE trial that showed a reduction of 18% in the rate of cardiovascular death, whilst the combination of perindopril and indapamide reduced blood pressure down to 134/75mmHg.
- The ONTARGET trial that compared the effectiveness of the angiotensin converting enzyme inhibitor (ramipril) with the angiotensin receptor blocker (telmisartan) showed that both drugs are similar in terms of their ability to reduce cardiovascular events.
- The ACCOMPLISH trial was the first to compare the combination of an angiotensin converting enzyme inhibitor with a calcium blocker (benazepril /amlodipine, respectively) versus the combination of an angiotensin converting enzyme inhibitor with a diuretic (benazepril/hydrochlorothiazide) finding that the first combination was significantly superior in reducing cardio-vascular events.
As Dr Emilio Kuschnir, cardiologist of the National University of Cordoba explains, the importance of these trials comparing different pharmacological strategies lies in the fact that: "Over the last few years the idea that patients with hypertension require the combination of two or more drugs, and that it is preferable to combine drugs than to use high doses of a single drug with the resulting increase in side effects, has become increasingly stronger."
Dr Zanchetti explains that: "these fixed combinations have also helped to improve treatment compliance."
The Burden Of Ignorance
Dr Guillermo Fabregues stated that: "Hypertension is the most important health problem in every region of the world. The Lancet journal recently published a trial showing that 7.5 million people died in 2001 as a consequence of hypertension. It is estimated that the burden of this disease in 2002 had doubled from 1990. The prevalence of hypertension continues to rise in the world and the majority of those suffering from hypertension pay insufficient attention to their condition and most of the patients aware of their condition are currently under treated."
Hypertension is a disease of the arterial wall that together with smoking, high cholesterol, diabetes, overweight and sedentary lifestyle is one of the main modifiable risk factors that leads to the development of cardiovascular disease. "It is considered that a person suffers from hypertension if after repeated blood pressure tests the pressure is equal or greater than 140/90 mmHg," says Dr Fabregues. "At present we have very effective treatments with few or no adverse effects that control this condition. The problem does not lie in being hypertensive but it lies in ignoring it. We can say that 50% of the people with hypertension do not know about their condition and it is estimated that only 1 in 10 people with hypertension have their blood pressure treated and under control."
A study performed in Sweden on patients who had suffered a stroke, one of the most dangerous vascular complications associated to high blood pressure, showed that only 1 out of 129 patients had their pressure treated and under control.
What does it mean to have blood pressure under control? "An adult with hypertension must keep his/her blood pressure below 140/90 mm H with the exception of people over 50 for whom the recommendation is that their pressure should not exceed 150/80 mmHg and diabetics who should lower their blood pressure levels below 130/80 mmHg," Dr Fábregues answered.
Hypertension Treatment
The topic of the optimal treatment of what cardiologists call "pre-hypertension"- that is when the levels of systolic pressure range between 120 and 139 mmHg and diastolic pressure between 80 and 89 mmHg, according to the North American Guidelines - will be discussed at the XVI World Congress of Cardiology because this classification is still under discussion.
"The European Guidelines do not use the term pre-hypertension," says Dr Zanchetti. They use a flexible definition of hypertension according to which pressure values within normal but high ranges (130-139/85-89 mmHg) are considered as hypertension if they are associated to diabetes, renal disease or the history of a stroke. Such patients should receive active hypertension treatment to lower their levels below 130/80 mmHg. When this blood pressure elevation is not associated to other risk factors the strategy is in the first place to recommend lifestyle changes."
"There is consensus at present that the treatment of this degree of hypertension consists in adopting a healthy lifestyle," says Dr Guillermo Fábregues. "Fundamentally a low sodium diet, daily physical activity, a balanced diet and no tobacco".
Dr Zanchetti concludes: "Once these lifestyle changes have been advised we have to wait for weeks and months to see if they are implemented and if they are effective in lowering the pressure levels down to normal values. Should this not happen, pharmacological treatment should not be delayed because the guidelines indicate that hypertension treatment can reduce risks at low hypertension values when initiated early.
About the World Heart Federation
The World Heart Federation is a nongovernmental organization based in Geneva, Switzerland dedicated to the prevention and control of heart disease and stroke, with a focus on low- and middle-income countries. It comprises 196 member societies of cardiology and heart foundations from over 100 countries covering the regions of Asia-Pacific, Europe, East Mediterranean, the Americas and Africa.
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The Argentine Society of Cardiology
The Argentine Society of Cardiology (SAC) was founded in 1937 and it is one of the world's oldest cardiology societies. Its members include many prestigious historical figures internationally recognized for their contributions to science including one Nobel Prize winner. SAC has more than 6,500 members in various categories including doctors, nurses and technicians. It has 36 Regional Districts spread over the entire national territory and 20 scientific councils representing all the subspecialties of cardiology. It conducts continuous and intensive teaching with courses in all subspecialties, grants the certification of cardiologists with the endorsement of various universities and conducts a programme of recertification training.
Other important areas of its role include research, with epidemiological surveys, clinical research studies and the "Consensus" which sets standards for diagnosis and treatment of major cardiovascular diseases. The society acts as advisor to both legislative chambers of the national parliament and it has established a community focused institution, the Argentine Foundation of Cardiology, to educate and prevent cardiovascular disease as well as running and dictating courses on cardiopulmonary resuscitation.
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The Argentine Federation of Cardiology
The Argentine Federation of Cardiology (FAC) is a scientific institution comprised of 37 cardiology organizations and 11 delegations from the Republic of Argentina. Its mission is to promote the harmonious and integrated development of Argentine cardiology to promote cardiovascular health. The Federation has 22 scientific committees with subspecialties devoted to research and scientific output. FAC publishes a hierarchical Scientific Magazine and through its Educational Programmes, develops regular activity focusing on immediate post-graduate education.
It also works closely with the CARDIO Foundation dealing with subjects related to the prevention of cardiovascular diseases and health education in the community.
To this purpose, the FAC issues a specialization certificate acknowledged by several provincial governments and has entered into agreements with numerous Argentine universities. For the past 40 years, the federation has published the Argentine Cardiology Federation Journal, now available both in paper and electronic version. Its 22 scientific committees develop a significant academic activity, and the recent creation of the Area of Institutional Scientific Consensus encourages such activities even further, coordinating the preparation of guidelines and recommendations. In this sense, the area of consensus promotes the interrelation with similar scientific societies, with the aim to ensure the wide dissemination and support of said guidelines and recommendations.
In addition, the FAC acts as permanent consultation body for numerous university and governmental organisms both at federal and provincial level.
Argentine Federation of Cardiology