FUN in Cardiology /pscc

1. Presenter Dr. Ihab Suliman Sponsor ASTRA-ZENECA

6. What do guidelines say? “ In subjects aged 80 years or over, evidence for antihypertensive treatment is as yet inconclusive ” ESH/ESC 2007 “ offer patients over 80 years of age the same treatment as other patients over 55, taking account of any comorbidity and their existing burden of drug use, but patients over 80 years of age are poorly represented in clinical trials and the effectiveness of treatment in this group is less certain” NICE 2007 “ For those aged over 80 at the time of diagnosis of hypertension, no clear guidance can be given” BHS 2004 No mention of over-80s, treated as other patients JNC7 2003 Statement Guidelines

7. Design of HYPVET

9. Jong et al. Arch Intern Med. 2002;162:1689-1694. Age- and Sex-Stratified Case-Fatality Rates 30 Days and 1 Year After First Hospitalization for HF Men Women Mortality, % Mortality, % Age Group, y No. of Patients 30-Day 1-Year No. of Patients 30-Day 1-Year 20-49 50-64 65-74 ≥ 75 All Ages 655 3048 5923 9310 18,936 4.6 5.5 8.6 15.6 11.4 15.0 20.5 28.8 43.1 34.0 375 1892 4412 13,087 19,766 4.3 5.4 6.8 14.7 11.8 10.9 19.5 23.0 37.9 32.3

14. NEJM 29TH MARCH 2009

19. Months from Randomization Cumulative Incidence of Primary Events (%) 40 - 0 - 10 - 20 - 30 - 0 6 12 18 24 36 42 30 48 60 54 2067 1929 1812 1730 1640 1513 1291 1569 1088 497 816 2061 1921 1808 1715 1618 1466 1246 1539 1051 446 776 No. at Risk Irbesartan Placebo HR (95% CI) = 0.95 (0.86-1.05) Log-rank p=0.35 Placebo Irbesartan

20. NEJM 16-4-2009

29. J ustification for the U se of statins in P rimary prevention: an I ntervention T rial E valuating R osuvastatin Ridker P et al . N Eng J Med 2008; 359 : 2195-2207