Abstract
Introduction: An increasing proportion of the population is reaching the ninth decade of life and beyond. Many of these individuals are active and contributory members of society, but most at this stage of life are hypertensive. Epidemiologic data indicate that for individuals in their 80s, as for younger age groups, increasing levels of systolic blood pressure are associated with increased risks of major cardiovascular events and strokes [ 1 ]. Only limited information has been available about whether treating hypertension in older age groups provides the same benefi ts as demonstrated in large hypertension outcomes studies. The number of patients in their 80s or older in these clinical trials has been insuffi cient to justify conclusions regarding the value of treating the elderly. Some fi ndings in the Systolic Hypertension in the Elderly Program (SHEP) suggested a reduction in major events in this age group, but patient numbers were inadequate to permit fi rm conclusions [ 2 ]. A meta-analysis based on several hypertension trials indicated that although active treatment decreased stroke incidence in patients in this age group, there appeared to be an offsetting increase in total mortality [ 3 ]. Moreover, a pilot study for the trial reported here, the Hypertension in the Very Elderly Trial (HYVET), showed that the stroke benefi ts from treating elderly patients appeared to be associated with an increase in overall death rates [ 4 ]. In the context of this critical uncertainty regarding the treatment of hypertensive individuals in their 80s or beyond, it was appropriate and ethically proper to design and carry out a major prospective trial in such individuals in whom clinical outcomes could be compared between active therapy and placebo.
Published Version
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