Treatment of hypertension in patients 80 years of age or older

Beckett, Nigel S.; Peters, Ruth; Fletcher, Astrid E.; Staessen, Jan A.; Liu, Lisheng; Dumitrascu, Dan; Stoyanovsky, Vassil; Antikainen, Riitta L.; Nikitin, Yuri; Anderson, Craig; Belhani, Alli; Forette, Françoise; Rajkumar, Chakravarthi; Thijs, Lutgarde; Banya, Winston; Bulpitt, Christopher J.

doi:10.1056/nejmoa0801369

Cited by 3,092Blood Pressure and Hypertension StudiesCardiovascular Health and Disease PreventionSodium Intake and Health

Treatment of hypertension in patients 80 years of age or older

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Beckett, Nigel S., Peters, Ruth, Fletcher, Astrid E., Staessen, Jan A., Liu, Lisheng, Dumitrascu, Dan, Stoyanovsky, Vassil, Antikainen, Riitta L. +8 more·2008·New England Journal of Medicine

DOI 10.1056/nejmoa0801369

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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].).

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There is strong evidence from clinical trials of the value of treating hypertension in older adults.
“There is strong evidence from clinical trials of the value of treating hypertension in older adults (70,71), with treatment of hypertension to individualized target levels indicated in most.”
From 13. Older Adults: Standards of Care in Diabetes—2024 (2024) · cites this paper as [70]
There is strong evidence from clinical trials of the value of treating hypertension in older adults.
“There is strong evidence from clinical trials of the value of treating hypertension in older adults (72,73), with treatment of hypertension to individualized target levels indicated in most.”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [72]
There is strong evidence from clinical trials of the value of treating hypertension in older adults.
“There is strong evidence from clinical trials of the value of treating hypertension in older adults”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [79]
The extent to which HYVET data can be extrapolated to more fragile octogenarians is uncertain because HYVET patients were generally in good condition.
“Because patients in the Hypertension in the Very Elderly Trial (HYVET) were generally in a good condition, 433 the extent to which HYVET data can be extrapolated to more fragile octogenarians is uncertain.”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [433]
There is strong evidence from clinical trials of the value of treating hypertension in the elderly.
“There is strong evidence from clinical trials of the value of treating hypertension in the elderly (308,309).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [309]

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Authors: Beckett, N. S., Peters, R., Fletcher, A. E., Staessen, J. A., Liu, L., Dumitrascu, D., Stoyanovsky, V., Antikainen, R. L., Nikitin, Y., Anderson, C., Belhani, A., Forette, F., Rajkumar, C., Thijs, L., Banya, W., & Bulpitt, C. J.
Affiliations: Imperial College London (GB)
London School of Hygiene & Tropical Medicine (GB)
KU Leuven (BE)
Spitalul Clinic Județean de Urgență Cluj-Napoca (RO)
National Transport Hospital "Tzar Boris III" (BG)
The George Institute for Global Health (AU)
Hôpital Charles-Nicolle (TN)
Hôpital Broca (FR)
Brighton and Sussex Medical School (GB)
ORCID: Beckett, Nigel S.
Peters, Ruth
Fletcher, Astrid E.
Staessen, Jan A.
Liu, Lisheng
Dumitrascu, Dan
Anderson, Craig
Rajkumar, Chakravarthi
Thijs, Lutgarde
Banya, Winston
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2008-05
Volume: 358
Issue: 18
Pages: 1887-1898
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa0801369
OpenAlex: W2103881469
Cited by: 3,092
References: 35
Citations by year: 2026: 61 · 2025: 96 · 2024: 99 · 2023: 103 · 2022: 157 · 2021: 118 · 2020: 149 · 2019: 167 · 2018: 173 · 2017: 208 · 2016: 207 · 2015: 203 · 2014: 230 · 2013: 191 · 2012: 225
FWCI: 168.34
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
Lirias (submittedVersion, other-oa)
Figshare (submittedVersion, cc-by)
Funders: British Heart Foundation
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
Keywords: hypertension, elderly patients, antihypertensive therapy, indapamide, perindopril, stroke prevention, systolic blood pressure, heart failure, cardiovascular mortality, adverse events, blood pressure targets, diuretics, ACE inhibitors, serious adverse events
MeSH terms: Aged, 80 and over, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Blood Pressure, Cardiovascular Diseases, Diuretics, Double-Blind Method, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Hypertension, Indapamide, Male, Stroke, Perindopril, Kaplan-Meier Estimate

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