Bodegom, David van

Engelaer, Frouke M.

Westendorp, Rudi G.J.

Leiden University Scholary Publications

HYPERTENSION IN OCTOGENERIANSHypotension is more risky than hypertension in veryold peopleFrouke M Engelaer PhD student, David van Bodegom assistant professor of medicine at LeidenUniversity Medical Centre, Rudi G JWestendorp professor of medicine at Leiden University MedicalCentreLeyden Academy on Vitality and Ageing, 2333 AA Leiden, NetherlandsThe open label treatment extension of the original HYVETstudy received enthusiastic applause as further evidence fordirect and long term benefits of treating hypertension in veryold people (≥80 years).1 However, we should be cautious inextrapolating these findings to clinical practice.It has repeatedly been shown that hypotension, not hypertension,carries the greatest risk in very old people.2 Low blood pressuremay be a consequence of imminent heart failure, drug treatment,or both, whereas raised blood pressure may be reactive and canhave survival benefits by ensuring perfusion in critical organs.3It is therefore important to estimate the net benefit of bloodpressure lowering treatment. The latest Cochrane review ontreatment of hypertension in octogenarians weighs all theavailable evidence, including the HYVET study, but does notshow a survival benefit for treatment, the hazard ratio beingclose to unity.4 The HYVET studymay be the only trial to showa survival benefit because it recruited healthy octogenarians, asshown by the low levels of comorbidity at baseline and lowfatality rate in the placebo group.5The benefits of treating very healthy octogenarians withhypertension definitely outweigh the side effects. But it wouldbe a daunting task for clinicians to correctly identify these olderpeople in clinical practice.Competing interests: None declared.1 Beckett N, Peters R, Tuomilehto J, Swift C, Sever P, Potter J, et al; for the HYVET StudyGroup. Immediate and late benefits of treating very elderly people with hypertension:results from active treatment extension to Hypertension in the Very Elderly randomisedcontrolled trial. BMJ 2012;344:d7541. (4 January.)2 Van Bemmel T, Gussekloo J, Westendorp RG, Blauw GJ. In a population-basedprospective study, no association between high blood pressure and mortality after age85 years. J Hypertens 2006;24:287-92.3 Euser SM, van Bemmel T, Schram MT, Gussekloo J, Hofman A, Westendorp RG, et al.The effect of age on the association between blood pressure and cognitive function laterin life. J Am Geriatr Soc 2009;57:1232-7.4 Musini VM, Tejani AM, Basset K, Wright JM. Pharmacotherapy for hypertension in theelderly. Cochrane Database Syst Rev 2009;4:CD000028.5 Beckett N, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. Treatment ofhypertension in patients 80 years of age or older. N Engl J Med 2008;358:18.Cite this as: BMJ 2012;344:e721© BMJ Publishing Group Ltd 2012engelaer@leydenacademy.nlFor personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribeBMJ 2012;344:e721 doi: 10.1136/bmj.e721 (Published 31 January 2012) Page 1 of 1LettersLETTERS

Hypotension is more risky than hypertension in very old people

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Hypotension is more risky than hypertension in very old people

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