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1、Hypertension in the Very Elderly Lisheng LIU,Epidemiology HYVET Study,The prevalence of hypertension in elderly population for China & Japan from the national surveys conducted in 1992 & 1993,Japan definition: 160/95 mmHg; China definition: 160/95 mmHg or under antihypertensive treatment,XH Zhang, B
2、HLI 2009,The effect of SBP on stroke mortality by age groups in Chinese elderly populations,0.5,1.0,2.0,4.0,8.0,16.0,=180,SBP (mmHg),RR of stroke mortality,Age=78y Age=74-77y Age=70-73y,XH Zhang, BHLI 2009,Stroke mortality in Asian men from 1987 to 2007,Hong Kong,Japan,Korea,Singapore,China_rural,Ch
3、ina_urban,Mortality, per 100,000,Year,Stroke mortality in Asian women from 1987 to 2007,Year,Blood pressure and stroke mortality in the Chinese elderly cohort (n=4814),XH Zhang, BHLI 2009,Blood pressure and stroke mortality in the Chinese elderly cohort (n=4814),XH Zhang, BHLI 2009,The effects of BP
4、 on the risk of stroke mortality by age gr. in the elderly (Cox proportional hazard regression model, controlled for age and smoking, stratified by sex),XH Zhang, BHLI 2009,Stroke mortality (per 100,000 population per year) of elderly ( 80yrs) in Asia in the latest available year,XH Zhang, BHLI 2009
5、,The development trend of the elderly population( number in 100 million ),Data source：Du P. Policy research on aging in 21 century in China ,1999,BMI & Hypertension Prevalence （3257 sub., Beijing),Prevalence（）,BMI,age,XH Fang, Chinese J. of Epidemiology, 2002；23：28-31,Metabolic Syndrome in Beijing （
6、1827 sub., 2000）,SC Guan. Chinese J. of Geriatrics, 2006;25(3):219-221,Overweight & Obesity in Beijing （1827 sub., 2000）,SC Guan. Chinese J. of Geriatrics, 2006;25(3):219-221,BMI & 5 Yr. All Cause Mortality,=75岁,BMI,XH Fang, et al. Chinese J. of Epidemiology, 2002;23:28-31,Cognitive Function & 5 Yr.
7、 Survival Rate,FU (mon.),S. Meng, Chinese J. of Geriatrics, 2004;23:507-509,Renal Function (CISC cohort),GFR in each age group (weighted and not),The over-80s are the fastest-growing group on the planet Age and SBP are two major components of CV risk Antihypertensive therapy reduces CV risk and mort
8、ality in patients under 80,Conclusions,Epidemiology HYVET Study,Baseline data, Fall in SBP 20mmHg and/or fall in DBP 10mmHg,Baseline Data (Previous Cardiovascular History),Baseline data (Cardiovascular Risk factors),Reported characteristics of subjects at entry to the HYVET 1) in China and 2) in the
9、 other Countries. Statistical comparisons include a gender x region interaction term,CHF=Congestive Heart Failure; Gender difference (P0.01);Regional difference (P0.01);￥Statistically significant interaction term (P0.05),Gender difference(P0.05); Gender difference（P0.0 I）;Regional difference (P0.01)
10、Regional difference (P0.05);￥Gender regional interaction term (P0.05) ￥ Gender regional interaction term (P0.01),Measurements on subjects entered in the HYVET at baseline,Chinese subjects in HYVET,Were slightly younger, had less previous hypertension but more previous strokes. Smoked more than the o
11、ther trial participants but drank less alcohol. Less previous episodes of MI, lighter & shorter. Had lower mean concentrations of blood urea, uric acid and Cr & higher concentrations of HDLC. Blood glucose & TC lower. Serum Na & K, blood haematocrit & Hb were all lower.,Blood pressure separation,Med
12、ian follow-up 1.8 years,15 mmHg,6 mmHg,All stroke (30% reduction),Placebo IndapamideSR perindopril,Indapamide SR perindopril,Placebo,P=0.055,Total Mortality (21% reduction),Placebo,Indapamide SR perindopril,P=0.019,Placebo IndapamideSR perindopril,Fatal Stroke (39% reduction),Indapamide SR perindopr
13、il,Placebo,P=0.046,Placebo IndapamideSR perindopril,Heart Failure (64% reduction),P0.0001,Placebo,IndapamideSR perindopril,Placebo IndapamideSR perindopril,ITT Summary,Per-Protocol,Biochemical Changes from Baseline (2 year cohort),In 2 year cohort there were no significant differences between the gr
14、oups with regard to change in serum.PotassiumUric acidGlucoseCreatinineAt 2 years 73.4% on combination treatment in act. (85.2% pl.),Safety,Reported serious adverse events (after randomisation)448 in the placebo group vs 358 in active (p=0.001)Only 5 categorised by the local investigator possible SA
15、DRs (3 in placebo group, 2 being in active),Conclusions,Antihypertensive treatment based on indapamide (SR) 1.5mg ( perindopril) reduced stroke mortality and total mortality in a very elderly cohort.NNT (2 years) = 94 for stroke 40 for mortalityLarge and significant benefit in reduction of heart fai
16、lure events and for combined endpoint of cardiovascular eventsBenefits seen earlyTreatment regime employed was safe,Cautions,Subjects recruited generally healthier than those within a general population Benefit from treating systolic pressures less than 160mmHg requires further research Target BP was 150/80 mmHg Benefit from lower targets still needs to be established,
