Kidney function in the very elderly with hypertension: data from the hypertension in the very elderly (HYVET) trial

Age Ageing. 2013 Mar;42(2):253-8. doi: 10.1093/ageing/afs109. Epub 2012 Aug 21.


Background: numerous reports have linked impaired kidney function to a higher risk of cardiovascular events and mortality. There are relatively few data relating to kidney function in the very elderly.

Methods: the Hypertension in the Very Elderly Trial (HYVET) was a randomised placebo-controlled trial of indapamide slow release 1.5mg ± perindopril 2-4 mg in those aged ≥80 years with sitting systolic blood pressures of ≥160 mmHg and diastolic pressures of <110 mmHg. Kidney function was a secondary outcome.

Results: HYVET recruited 3,845 participants. The mean baseline estimated glomerular filtration rate (eGFR) was 61.7 ml/min/1.73 m(2). When categories of the eGFR were examined, there was a possible U-shaped relationship between eGFR, total mortality, cardiovascular mortality and events. The nadir of the U was the eGFR category ≥60 and <75 ml/min/1.73 m(2). Using this as a comparator, the U shape was clearest for cardiovascular mortality with the eGFR <45 ml/min/1.73 m(2) and ≥75 ml/min/1.73 m(2) showing hazard ratios of 1.88 (95% CI: 1.2-2.96) and 1.36 (0.94-1.98) by comparison. Proteinuria at baseline was also associated with an increased risk of later heart failure events and mortality.

Conclusions: although these results should be interpreted with caution, it may be that in very elderly individuals with hypertension both low and high eGFR indicate increased risk.

Trial registration: NCT00122811.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged, 80 and over
  • Aging*
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure* / drug effects
  • Delayed-Action Preparations
  • Diuretics / therapeutic use
  • Drug Therapy, Combination
  • Female
  • Glomerular Filtration Rate*
  • Heart Failure / mortality
  • Heart Failure / physiopathology
  • Humans
  • Hypertension / drug therapy
  • Hypertension / mortality
  • Hypertension / physiopathology*
  • Indapamide / therapeutic use
  • Kidney / physiopathology*
  • Kidney Diseases / mortality
  • Kidney Diseases / physiopathology*
  • Male
  • Perindopril / therapeutic use
  • Proportional Hazards Models
  • Proteinuria / physiopathology
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome


  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Delayed-Action Preparations
  • Diuretics
  • Indapamide
  • Perindopril

Associated data