Evidence map›Paper›PMID 25880068›Full record

Trial reportBMC medicine2015

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.

Jane Warwick, Emanuela Falaschetti, Kenneth Rockwood, Arnold Mitnitski, Lutgarde Thijs, Nigel Beckett, Christopher Bulpitt, Ruth Peters

Registry-linked trialOpen access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00122811 (The Hypertension in the Very Elderly Trial), which is not on this map. Cited by 128 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
128citing papers in PubMed, 15 pooled it
19.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00122811 phase4unknown statusnot on this map

The Hypertension in the Very Elderly Trial (HYVET)

TypeinterventionalSponsorImperial College LondonRan2000 to 2008Enrolled4,000ConditionsHypertensionArmsIndapamide SR 1.5mg, Perindopril 2-4mg
3 · Its place in the literature

Who cites it

128 citing papers in PubMed, 15 syntheses or guidelines pooled it, 321 citations in OpenAlex.

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  9. [Integrated Care Protocol: Hypertension].Revista medica del Instituto Mexicano del Seguro Social · 2022
    Guideline
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  11. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019).Hypertension research : official journal of the Japanese Society of Hypertension · 2019
    Guideline
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68 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 2 countries.

Jane WarwickWarwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK. j.warwick@warwick.ac.uk.
Emanuela FalaschettiImperial Clinical Trials Unit, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK. e.falaschetti@imperial.ac.uk.
Kenneth RockwoodGeriatric Medicine, Dalhousie University, Queen Elizabeth II Health Sciences Centre, 1421-5955 Veterans' Memorial Lane, Halifax, B3H 1C6, Nova Scotia, Canada. kenneth.rockwood@dal.ca.
Arnold MitnitskiDepartment of Medicine, Dalhousie University, Centre for Health Care of the Elderly, 1421-5955 Veterans' Memorial Lane, Halifax, B3H 2E1, Nova Scotia, Canada. arnold.mitnitski@dal.ca.
Lutgarde ThijsStudies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, Box 7001, BE-3000, Leuven, Belgium. lutgarde.thijs@med.kuleuven.be.
Nigel BeckettDepartment of Medicine, Imperial College London, Hammersmith Campus, London, W12 0NN, UK. n.beckett@imperial.ac.uk.
Christopher BulpittDepartment of Medicine, Imperial College London, Hammersmith Campus, London, W12 0NN, UK. c.bulpitt@imperial.ac.uk.
Ruth PetersImperial Clinical Trials Unit, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK. r.peters@imperial.ac.uk.
Imperial College London · GBKU Leuven · BEUniversity of Warwick · GB

Funding

Department of Health PDF-2012-05-197The Dunhill Medical Trust R287/0213
6 · The paper itself

Abstract

backgroundTreatment 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.

methodsParticipants 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.

resultsWe 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.

conclusionsFurther work to examine whether antihypertensive treatment modifies frailty as measured by the FI should be explored.

trial registrationClinicalTrials.gov NCT00122811 (July 2005).

Indexed as

Frail ElderlyAged, 80 and overAntihypertensive AgentsBlood PressureComorbidityDouble-Blind MethodDrug Therapy, CombinationFemaleHumansHypertensionIncidenceIndapamideMalePerindoprilQuality of LifeStrokeAntihypertensive AgentsIndapamidePerindopril

Identifiers

PMID25880068
PMCPMC4404571
OpenAlexW2035774055

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.