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The Hypertension in the Very Elderly Trial (HYVET)

Rationale, Methodology and Comparison with Previous Trials

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  • Drug Therapy
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Summary

The Hypertension in the Very Elderly Trial (HYVET) is a multicentre, open, randomised, 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 219mm Hg plus a sustained sitting diastolic pressure of 95 to 109mm Hg. Also required is a standing systolic blood pressure of at least 140mm 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 randomised 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 (< 150/80mm 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.

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Authors and Affiliations

  1. Division of Geriatric Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, Du Cane Road, London, W12 0NN, England

    Christopher J. Bulpitt, Sara Lightowlers & Alison Palmer

  2. Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, London, England

    Astrid E. Fletcher

  3. Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, University of Leuven, Leuven, Belgium

    Antoon Amery & Jan Staessen

  4. The Waterhouse, Bollington, Cheshire, England

    John Coope

  5. Nuffield Department of Clinical Medicine, Geriatric Medicine Division, Radcliffe Infirmary, Oxford, England

    J. Grimley Evans

  6. Royal College of Surgeons in Ireland, Dublin, Ireland

    Kevin O’Malley

  7. University Department of Medicine/Elderly, The Glenfield Hospital, Leicester, England

    John Potter

  8. Department of Clinical Pharmacology, St Mary’s Hospital Medical School, Queen Elizabeth the Queen Mother Wing, London, England

    Peter Sever

  9. Department of Health Care/Elderly, King’s College School of Medicine, King’s College Hospital (Dulwich), London, England

    Cameron Swift

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Bulpitt, C.J., Fletcher, A.E., Amery, A. et al. The Hypertension in the Very Elderly Trial (HYVET). Drugs & Aging 5, 171–183 (1994). https://doi.org/10.2165/00002512-199405030-00003

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