Resumen
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.
| Idioma original | English |
|---|---|
| Número de artículo | 78 |
| Publicación | BMC Medicine |
| Volumen | 13 |
| N.º | 1 |
| DOI | |
| Estado | Published - abr. 9 2015 |
Nota bibliográfica
Funding Information:Financial disclosure: This work was supported by The Dunhill Medical Trust [grant number: R287/0213] and benefited from facilities funded through Birmingham Science City Translational Medicine Clinical Research and Infrastructure Trials Platform, with support from Advantage West Midlands. The data used for these analyses comes from the HYVET study, which was funded by grants from the British Heart Foundation and the Institute de Recherches Internationales Servier, and sponsored by Imperial College London. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. All persons mentioned in the acknowledgements have given written consent. The committee members and investigators for HYVET were as follows: Co-ordinating Centre: CJ Bulpitt (lead investigator), AE Fletcher (co-investigator), NS Beckett (trial coordinator), R Peters (deputy trial coordinator), HYVET coordinating team at Imperial College London (1999 to 2008). HYVET Committees: Steering Committee: T McCormack, J Potter, BG Extremera, P Sever, F Forette, D Dumitrascu, C Swift, J Tuomilehto, J Coope (retired in 2001), C Nachev (deceased); Data Monitoring Committee: J Staessen, L Thijs, R Clarke, K Narkiewicz; End Points Committee: C Davidson (retired in 2003), J Duggan, G Leonetti, N Gainsborough, MC De Vernejoul, J Wang, V Stoyanovsky; Dementia Validation Committee: J Tuomilehto, R Clarke, A Waldman, I Walton, C Ritchie; Ethics Committee: R Fagard, J Grimley Evans, B Williams; Investigators: (*National Co-ordinators) Australia — R Warne* and I Puddey*, M Woodward, R Penhall, C Inderjeeth, S Roger, R Scholes, C Johnson; Belgium — H Celis*, G Adriaens, W Onsea, K Cornelli, D Vantroyen, P Cleen, P de Voogt; Bulgaria — C Nachev* (deceased) (national coordinator from 1998 to 2005), V Stoyanovsky* (national coordinator after 2005), P Solakov, R Prokopova, E Mantova, D Smilkova, S Mantov, K Yankulova, R Kermova, D Popov, V Sirakova, V Gergova, D Kamenova, F Grigorov, T Vassileva, R Alahverdian, M Tzekova; A Postadjian, M Geneva, V Mincheva, T Petrusheva, A Toncheva, I Gruev, V Tsanova; China — L Liu*, H Ge, S Wang, J Wang, W Zhang, S Jin, L Ge, YF Lu, S Ma, L Shen, J Guo, Z Lv (deceased), R Huang, X Li, B Guo, GE Yuan, T Zhang, L Zhang, J Feng, Z He, J Wang, L Deng, L Liu, Q Yuan, F Zhang, H Li, D Wang, K Yang, M Sun, H Liu, X Yan, F Ren, J Tang, M Zhao, X Luo, H Zhou, H Sang, J Wang, L Yan, Z Wang, J Zhang, C Wang; Finland — R Antikainen*, T Strandberg, T Konttila, A Hynninen, M Jääskivi, J Airas, T Jääskeläinen, J Tuomilehto, H Litmanen, T Karhi, H Yliharsila; France — F Forette*, J Doucet, J Belmin, A Benetos, G Berrut, T Boge, M Bonnefoy, A Carre, N Charasz, J Covillard, T Dantoine, M Escande, Y Frances, R Joire, C Jeandel, S Legrain, A Lion, M Maillet-Vioud, JP Escaillas, S Meaume, P Pfitzenmeyer, F Puisieux, E Quercy, O Rodat, J Soubeyrand, B de Wazieres, H Hindennach, L Lugassy, J Rossi, M Martel, J-M Paladel, C Ravier, A Visconti, JP Gallet, D Zygouritsas, D Charles, F Flamand, G Grandmottet, M Grandmottetegermann, C Gevrey, PL Mesnier, G Robert, C Besset-Prat, A Brousse, P Lafont, J Morelli, P Vernede, A Volkmann, X Bodin, B Destrube, R Eoche, A Boye, F Seropian, P Gernigon, D Meker, J Thomere, Y Thual, F Volny, E Grassart, M Herent, D Lejay, J-P Lopez, B Mannessier, G Pruvost, J-C Urbina; Ireland — J Duggan*; New Zealand — C Anderson*, S Lillis, J Gommans, H Senior; Poland — T Grodzicki*, Z Chodorowski, Z Gaciong; Romania — D Dumitrascu*, M Comsa, V Sandru, G Prada, M Dunca-Moisin, D Jianu, D Jinga-Lazar, V Enachescu, C Zaharia; Russia — Y Nikitin*, A Kirichenko, L Olbinskaya, A Martynov, V Zadionchenko, V Moiseev, G Storohzakov, S Nedogoda, RS Karpov, O Barbarash, G Efremushkin, V Kostenko, M Boyarkin, S Churina, T Tyurina, M Ballyuzek, L Ermoshkina, A Timofeev, S Yakusheva, N Shilkina, V Barbarich, L Latunceva, S Burakova, T Ripp, S Pekarsky, V Mordovin; Tunisia — A Belhani*, E Boughzela, S Soraya, B Youssef-Zouari, AB Khalfallah, MH Houman, AK Abida; United Kingdom — C Rajkumar*, M Wilkins, ND Pandita-Gunawardena, J Potter, E Ekpo, M Price, N de Kare-Silver, A Starczewski, S Chandran, N Nasar, M Datta-Chaudhuri, T McCormack, N Majmudar, A Gordon, L Brawn, T Solanki, F Dockery, R Schiff. We wish to acknowledge the work of Professor C Nachev (Steering committee member, National Co-ordinator of Bulgaria and HYVET investigator from 1998 until his death in 2005).
Publisher Copyright:
© Warwick et al.; licensee BioMed Central.
ASJC Scopus Subject Areas
- General Medicine