NEJM: Octogenarians benefit from antihypertension treatment

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Antihypertensive treatment with indapamide (Lozol) (sustained release), with or without perindopril (Aceon), in persons 80 years of age or older is beneficial, according to a study published May 1 in the New England Journal of Medicine (NEJM).

Nigel S. Beckett, MB, ChB, from the Imperial College of London, and colleagues randomly assigned 3,845 patients from Europe, China, Australasia and Tunisia, who were 80 years of age or older. The participants also had a sustained systolic blood pressure of 160 mm Hg or more to receive either the diuretic indapamide (sustained release, 1.5 mg) or matching placebo.

The angiotensin-converting–enzyme inhibitor perindopril (2 or 4 mg), or matching placebo, was added if necessary to achieve the target blood pressure of 150/80 mm Hg.

The primary end point was fatal or nonfatal stroke, according to researchers.

The authors wrote that the active-treatment group (1,933 patients) and the placebo group (1,912 patients) were well-matched (mean age, 83.6 years; mean blood pressure while sitting, 173.0/90.8 mm Hg); 11.8 percent had a history of cardiovascular disease. Median follow-up was 1.8 years.

At two years, the researchers found that the mean blood pressure while sitting was 15.0/6.1 mm Hg lower in the active-treatment group than in the placebo group.
In an intention-to-treat analysis, Beckett and colleagues found that active treatment was associated with a 30 percent reduction in the rate of fatal or nonfatal stroke, a 39 percent reduction in the rate of death from stroke, a 21 percent reduction in the rate of death from any cause, a 23 percent reduction in the rate of death from cardiovascular causes and a 64 percent reduction in the rate of heart failure.

Fewer serious adverse events were reported in the active-treatment group (358, vs. 448 in the placebo group), according to researchers.

Aventis Pharmaceuticals of Bridgewater, N.J., distributes Lozol, and generic versions are also available.