BACKGROUND: fractures may have serious implications in an elderly individual, and fracture prevention may include a careful choice of medications. DESIGN: the Hypertension in the Very Elderly Trial (HYVET) was a double-blind placebo-controlled trial of a thiazide-like diuretic (indapamide 1.5 mg SR) with the optional addition of the angiotensin-converting enzyme (ACE) inhibitor (perindopril 2-4 mg). Fracture was a secondary end point of the trial. SETTING:HYVET recruited participants from Eastern and Western Europe, China, Australasia, and Tunisia. SUBJECTS:all participants were > or =80 years of age and hypertensive. METHODS: participants were randomised to receive a thiazide-like diuretic (indapamide 1.5 mg SR) +/- ACE inhibitor (perindopril 2-4 mg) or matching placebos. Incident fractures were validated and analysed based on time to first fracture. RESULTS: there were 3,845 participants in HYVET and a total 102 reported fractures (42 in the active and 60 in the placebo group). When taking only validated first fractures, 90 were included in the analyses (38 in the active and 52 in the placebo group). Cox proportional hazard regression, adjusted for key baseline risk factors, resulted in a point estimate of 0.58 (95% CI 0.33-1.00, P = 0.0498). CONCLUSIONS: despite the lowering of blood pressure, treatment with a thiazide-like diuretic and an ACE inhibitor does not increase and may decrease fracture rate.
RCT Entities:
BACKGROUND:fractures may have serious implications in an elderly individual, and fracture prevention may include a careful choice of medications. DESIGN: the Hypertension in the Very Elderly Trial (HYVET) was a double-blind placebo-controlled trial of a thiazide-like diuretic (indapamide 1.5 mg SR) with the optional addition of the angiotensin-converting enzyme (ACE) inhibitor (perindopril 2-4 mg). Fracture was a secondary end point of the trial. SETTING: HYVET recruited participants from Eastern and Western Europe, China, Australasia, and Tunisia. SUBJECTS: all participants were > or =80 years of age and hypertensive. METHODS:participants were randomised to receive a thiazide-like diuretic (indapamide 1.5 mg SR) +/- ACE inhibitor (perindopril 2-4 mg) or matching placebos. Incident fractures were validated and analysed based on time to first fracture. RESULTS: there were 3,845 participants in HYVET and a total 102 reported fractures (42 in the active and 60 in the placebo group). When taking only validated first fractures, 90 were included in the analyses (38 in the active and 52 in the placebo group). Cox proportional hazard regression, adjusted for key baseline risk factors, resulted in a point estimate of 0.58 (95% CI 0.33-1.00, P = 0.0498). CONCLUSIONS: despite the lowering of blood pressure, treatment with a thiazide-like diuretic and an ACE inhibitor does not increase and may decrease fracture rate.
Authors: Daichi Shimbo; C Barrett Bowling; Emily B Levitan; Luqin Deng; John J Sim; Lei Huang; Kristi Reynolds; Paul Muntner Journal: Circ Cardiovasc Qual Outcomes Date: 2016-05-10
Authors: Karen L Margolis; Lisa Palermo; Eric Vittinghoff; Gregory W Evans; Hal H Atkinson; Bruce P Hamilton; Robert G Josse; Patrick J O'Connor; Debra L Simmons; Margaret Tiktin; Ann V Schwartz Journal: J Gen Intern Med Date: 2014-08-16 Impact factor: 5.128
Authors: Joshua I Barzilay; Barry R Davis; Sara L Pressel; Alokananda Ghosh; Rachel Puttnam; Karen L Margolis; Paul K Whelton Journal: Curr Cardiol Rep Date: 2017-09 Impact factor: 2.931
Authors: Samantha G Bromfield; Cedric-Anthony Ngameni; Lisandro D Colantonio; C Barrett Bowling; Daichi Shimbo; Kristi Reynolds; Monika M Safford; Maciej Banach; Peter P Toth; Paul Muntner Journal: Hypertension Date: 2017-06-26 Impact factor: 10.190