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

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.