Monday, August 13, 2007

What if I have hypertension at 80?

What would you do if you have hypertension, when you are 75 or 80 yrs old? Would you want to take pills daily for the rest of your life or would you just leave it alone, as you are old enough? What is life at 80? To live longer or to live better?

For a long time, we did not know if treating hypertension at 80 made any difference. Studies that included this age group, in many clinical trials, were in small numbers and in many ways, not definitive. Well, that was until Dr Chris Bulpitt of Imperial College (UK), announced this week the premature closure of the "Hypertension in the Very Elderly Trial". This trial was due to be completed by 2009. But the Drug safety and monitoring committee advised the early stopped to the study because there was an obvious benefit in treatment. They decided to open the label, and allow the patients in the placebo group to take the treatment.

This study included 3845 patients who were all over 80 yrs. They all had hypertension, and they come from across the world including Eastern and Western Europe, Tunisia and China. The treatment arm received the usual dose of indapamide and coversyl. There was a significant reduction in strokes and cardiac mortality in the treatment arm. Basically, lowering blood pressure to target, will reduce the rates of strokes and also cardiac deaths. At 80, stroke is a real devastator and makes life so different. Reduction in cardiac mortality, in this age group, is a moot point. Living well may be, in my opinion, much much more important.

Indapamide and coversyl, are both fairly cheap and well tolerated drugs. The dose of coversyl were only 2-4 mgs instead of the big 8mgs dose of coversyl that is now being pushed around. The side effects were low. Even in my own practice, treatment was very individualised. Sometimes I treat, and usually with an ACE-I or Natrilix SR (Indapamide), and sometimes, I just leave them on moderate lifestyle changes. Natrilix SR has, in my practice, been a very useful drug, effective and safe. I suppose, the message here would be that, it is still very worthwhile to treat octogenarians with significant hypertension.

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