Studie Hyvet a HYVET-COG
Léčba velmi starých hypertoniků

Česká verzia

Authors: J. Widimský
Published in the journal: Kardiol Rev Int Med 2008, 10(4): 141-146

Summary

The effect of hypertensi on tre atment on cognitive faculti es – HYVET- COG study. Until recently, it was not known whether very old pe ople co uld also benefit from the tre atment of hypertensi on. The HYVET study presents the first prospective, do uble- blind study evalu ating the effect of antihypertensive tre atment in the above age gro up (80 ye ars and above). A total of 3,845 pati ents with me an age 83.6 ye ars were randomised to an active therapy gro up and a placebo gro up. The average se ated blo od pressure pri or to the start of therapy was 173.0/ 90.8 mmHg. Indapamide 1.5 mg was used for active therapy. A dose of 2 mg or 4 mg of perindopril co uld be added to the active tre atment if BP target values < 150/ < 80 mmHg were not achi eved. After two ye ars of durati on of the study, the average se ated BP in the actively tre ated gro up was by 15.0/ 6.1 mmHg lower as compared with the placebo gro up. The target BP values < 150/ < 80 mmHg were achi eved in almost 50 % of pati ents. The HYVET study was prematurely discontinued on ethical gro unds by the data monitoring committee after a 1.8 ye ar tre atment medi an as a result of a significant difference in the total mortality and fatal cerebrovascular events rates in favo ur of the actively tre ated gro up. Overall mortality was significantly reduced by 21 % (p = 0.02), fatal cerebrovascular events by 39 % (p = 0.045), and the incidence of he art failure by 64 % (p < 0.001). The tre atment was very well tolerated and the incidence of adverse effects was lower than in the placebo gro up. The HYVET study provides important evidence of the fact that the tre atment of hypertensi on in very old persons based on indapamide (with sustained rele ase) combined with perindopril in more than 70 % of pati ents brings a highly positive result in very old hypertonic pati ents and reduces the risk of de ath for all ca uses, as well as fatal cerebrovascular events and the incidence of he art failure. The HYVET- COG study which forms part of the HYVET study was focused on the issue of the relati on between the tre atment of hypertensi on and cognitive decline and the incidence of dementi a. The study has shown that tre atment of hypertensi on in very old pe ople results in a trend towards a less cognitive decline and towards lower incidence of dementi a. The above decre ase has not assumed statistical significance mainly beca use of the fact that the study had to be prematurely interrupted for a significant difference in overall mortality and in the incidence of fatal cerebrovascular events. However, meta‑analysis of the fo ur studi es focussing the issue of preventi on of dementi a within primary or secondary preventi on showed the capacity of hypertensi on tre atment to significantly decre ase the incidence of dementi a.

Key words:
hypertension in very old people – HYVET study – hypertension treatment – prevention of dementia – HYVET-COG

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