Cardiovascular
Should very old frail people still get blood-pressure pills?
Open access · cc by · source: Europe PMC
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.
How this study connects
Role on claims
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In HYVET, frailty did not cancel the stroke and CV benefit of antihypertensive treatment at age 80+.
In 2,656 HYVET participants aged 80+, median frailty index was 0.17. Indapamide±perindopril still cut fatal/non-fatal stroke (HR 0.64) and CV events (HR 0.59); FI×treatment interaction p-values were 0.52, 0.73, and 0.61.
Evidence for the claim as stated.
History
When this study was placed
Dated entries from the concept change log — when this paper was added or removed as support, challenge, or qualifier on a claim.
Placed as supporting evidence on Cardiovascular Care
In 2,656 HYVET participants aged 80+, median frailty index was 0.17. Indapamide±perindopril still cut fatal/non-fatal stroke (HR 0.64) and CV events (HR 0.59); FI×treatment interaction p-values were 0.52, 0.73, and 0.61.
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.
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Inspect source passages
Should very old frail people still get blood-pressure pills?
These passages occur verbatim in the stored paper text. They support the points listed below; they do not verify every statement in the explanation.
FI was calculable in 2,656 of 3,845 randomized participants.
The HYVET trial randomised 3,845 participants, of whom only the 2,656 who consented to complete an additional quality of life questionnaire provided sufficient data to allow the calculation of the FI.
Stroke HR on active treatment was 0.64 (95% CI 0.42–0.96).
Treatment with an anti-hypertensive was associated with a 36% reduction in risk of fatal and non-fatal stroke (HR, 0.64; 95% CI, 0.42–0.96; P = 0.03)
Key findings
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.
Methodology
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.
Limitations
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.
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