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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, a double-blind, placebo-controlled study of antihypertensives in people with hypertension aged 80 and over
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Warwick, Jane, Falaschetti, Emanuela, Rockwood, Kenneth, Mitnitski, Arnold, Thijs, Lutgarde, Beckett, Nigel, Bulpitt, Christopher and Peters, Ruth (2015) 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, a double-blind, placebo-controlled study of antihypertensives in people with hypertension aged 80 and over. BMC Medicine, Volume 13 (Number 1). doi:10.1186/s12916-015-0328-1 ISSN 1741-7015.
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Official URL: http://dx.doi.org/10.1186/s12916-015-0328-1
Abstract
Background Treatment 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. Methods Participants 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. Results We 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. Conclusions Further work to examine whether antihypertensive treatment modifies frailty as measured by the FI should be explored.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > R Medicine (General) | ||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Hypertension in old age, Frail elderly | ||||||||
| Journal or Publication Title: | BMC Medicine | ||||||||
| Publisher: | BioMed Central Ltd. | ||||||||
| ISSN: | 1741-7015 | ||||||||
| Official Date: | 9 April 2015 | ||||||||
| Dates: |
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| Volume: | Volume 13 | ||||||||
| Number: | Number 1 | ||||||||
| DOI: | 10.1186/s12916-015-0328-1 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||||
| Date of first compliant deposit: | 29 December 2015 | ||||||||
| Date of first compliant Open Access: | 29 December 2015 | ||||||||
| Funder: | Dunhill Medical Trust (DMT), Birmingham Science City, Advantage West Midlands (AWM), British Heart Foundation, Imperial College, London | ||||||||
| Grant number: | R287/0213 (DMT) |
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