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,Report as inadecuate




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, - Download this document for free, or read online. Document in PDF available to download.

BMC Medicine

, 13:78

First Online: 09 April 2015Received: 12 November 2014Accepted: 17 March 2015DOI: 10.1186-s12916-015-0328-1

Cite this article as: Warwick, J., Falaschetti, E., Rockwood, K. et al. BMC Med 2015 13: 78. doi:10.1186-s12916-015-0328-1

Abstract

BackgroundTreatment for hypertension with antihypertensive medication has been shown to reduce stroke, cardiovascular events, and mortality in older adults, but there is concern that such treatment may not be appropriate in frailer older adults. To investigate whether there is an interaction between effect of treatment for hypertension and frailty in older adults, we calculated the frailty index FI for all available participants from 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, and obtained frailty adjusted estimates of the effect of treatment with antihypertensive medication on risk of stroke, cardiovascular events, and mortality.

MethodsParticipants in HYVET were randomised 1:1 to active treatment with indapamide sustained release 1.5 mg ± perindopril 2 to 4 mg or to matching placebo. Data relating to blood pressure, comorbidities, cognitive function, depression, and quality of life were collected at entry into the study and at subsequent follow-up visits. The FI was calculated at entry, based on 60 potential deficits. The distribution of FI was similar to that seen in population studies of adults aged 80 years and above median FI, 0.17; IQR, 0.11–0.24. Cox regression was used to assess the impact of FI at entry to the study on subsequent risk of stroke, total mortality, and cardiovascular events. Models were stratified by region of recruitment and adjusted for sex and age at entry. Extending these models to include a term for a possible interaction between treatment for hypertension and FI provided a formula for the treatment effect as a function of FI. For all three models, the point estimates of the hazard ratios for the treatment effect decreased as FI increased, although to varying degrees and with varying certainty.

ResultsWe found no evidence of an interaction between effect of treatment for hypertension and frailty as measured by the FI. Both the frailer and the fitter older adults with hypertension appeared to gain from treatment.

ConclusionsFurther work to examine whether antihypertensive treatment modifies frailty as measured by the FI should be explored.

Trial registrationClinicalTrials.gov NCT00122811 July 2005

KeywordsAgeing Antihypertensives Frailty Hypertension AbbreviationsCIConfidence interval

FIFrailty Index

HRHazard ratio

HYVETHYpertension in the Very Elderly Trial

IQRInterquartile range

MMSEMini-Mental State Exam

SDStandard deviation

Electronic supplementary materialThe online version of this article doi:10.1186-s12916-015-0328-1 contains supplementary material, which is available to authorized users.

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Author: Jane Warwick - Emanuela Falaschetti - Kenneth Rockwood - Arnold Mitnitski - Lutgarde Thijs - Nigel Beckett - Christopher Bu

Source: https://link.springer.com/







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