Should very old frail people still get blood-pressure pills?
In 2,656 HYVET participants aged 80+, frailty did not cancel the benefit of indapamide±perindopril: stroke HR 0.64 and CV-event HR 0.59, with no significant FI×treatment interaction.
Source
No evidence that frailty modifies the positive impact of antihypertensive treatment in very elderly people: an investigation of the impact of frailty upon treatment effect in the HYpertension in the Very Elderly Trial (HYVET) study, a double-blind, placebo-controlled study of antihypertensives in people with hypertension aged 80 and over
Study at a glance
- Design
- RCT — Secondary frailty-index analysis of HYVET, a double-blind placebo-controlled antihypertensive RCT in people aged ≥80.
- N
- N=2656 · HYVET randomized 3,845; FI calculable in 2,656 with extra QoL data (1,324 placebo; 1,332 active).
- Population
- Hypertensive adults aged 80+ in HYVET (mean age ~83.5; ~61% women).
- Outcome
- Stroke, cardiovascular events, and total mortality; interaction of treatment with baseline 60-item frailty index.
Structured fields used in claim comparison tables when every cited study has a complete layer.
What they did
Built a 60-deficit frailty index at entry for HYVET participants who completed a quality-of-life questionnaire, then fit Cox models for stroke, CV events, and death with a treatment×FI interaction, stratified by region and adjusted for age and sex.
What they found
Median FI was 0.17 (IQR 0.11–0.24). Active treatment still cut fatal/non-fatal stroke (HR 0.64) and CV events (HR 0.59); total mortality HR 0.83 was not significant. Interaction p-values were 0.52, 0.73, and 0.61. Point estimates even suggested larger relative benefit at higher FI, with wide CIs.
The limits
What it doesn't show
FI was missing in 1,189 randomized patients (slightly higher MMSE in those without FI), so the frailest of the frail may be under-represented; HYVET already excluded many very sick elders.
Key terms
- HYVET
- Hypertension in the Very Elderly Trial: double-blind RCT of indapamide SR 1.5 mg ± perindopril vs placebo in people ≥80 (NCT00122811).
- Frailty index (FI)
- Proportion of 60 potential deficits present at entry (median 0.17).
- Treatment×frailty interaction
- Test of whether antihypertensive benefit shrinks as FI rises; none was significant.
- Indapamide SR
- Active-arm thiazide-like diuretic 1.5 mg, with optional perindopril 2–4 mg.
- Very elderly hypertension
- HYVET population: mean age ~83.5 years with sitting SBP ~173 mmHg.
Flashcards
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FI was available for about:
Common questions
How many people had an FI?
2,656 of 3,845 randomized HYVET participants.
Did frailty wipe out treatment benefit?
No—no significant interaction for stroke, CV events, or death.
Stroke HR on active treatment?
0.64 (95% CI 0.42–0.96) after FI, age, and sex adjustment.
What drug was studied?
Indapamide sustained-release 1.5 mg ± perindopril 2–4 mg vs placebo.
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