Lowering blood pressure in very elderly patients reduces total risk of death by one fifth and rate of cardiovascular events by one third, according to results of the Hypertension in the Very Elderly (HYVET) study, presented yesterday at the American College of Cardiology Annual Scientific Meeting in Chicago and published online in the New England Journal of Medicine.

HYVET randomised 3845 patients aged 80 years and older who had high blood pressure (mean 173/91 mmHg) to placebo or a regimen consisting of two Servier drugs: the diuretic Lozol/Natrilix (indapamide SR) 1.5 mg with or without the ACE inhibitor Aceon/Coversyl (perindopril) 2-4 mg once a day. After two years, 48% of patients receiving active treatment achieved the target blood pressure of 150/80 mmHg compared with 20% in the placebo group.

The study was stopped early in July 2007 after the second planned interim analysis showed a significant reduction in the risk of non-fatal and fatal stroke (the primary endpoint) and total risk of death. Final results reported in Chicago included a 21% reduction in total mortality and 30% reduction in the rate of all strokes, though the latter did not reach statistical significance. There were, however, significant reductions of 39% in the risk of fatal stroke, 64% in fatal and non-fatal heart failure and 35% in cardiovascular events. These benefits were clear in the first year of follow-up, and the treatment regimen was well tolerated.

HYVET will have important implications for future clinical guidelines, since it is the largest randomised controlled trial to assess the potential benefits of treating high blood pressure in people aged 80 years and older. According to lead investigator Dr Nigel Beckett, Imperial College, London, HYVET also refutes epidemiological studies indicating that lowering blood pressure might increase the risk of death in very elderly people. He added: "“HYVET shows that it is never too late to start antihypertensive medication, and we have expanded the upper limit where there is clinical evidence of benefit for the treatment of hypertension.”"

It remains unclear whether there would be any added benefit in lowering blood pressure any further in the over-80s. There is also unlikely to be wholesale initiation of blood-pressure lowering treatment in this age group, since the HYVET patients were generally healthier than many seen in clinical practice. However, increasing numbers of people do reach a fit and healthy old age and stand to benefit from treatment of their high blood pressure. Servier is well placed to benefit, but other companies could also profit from this expanding market. By Sue Lyon in Chicago