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Waiting for evidence is sometime like waiting for Godot. The question is obvious, but the trial is never done. One such often-asked question is whether treating high blood pressure in the very elderly is worthwhile. Maybe they will not respond as well as the younger patients? And maybe they will have more adverse effects, or are likely to die of something else before they can benefit? Hence my colleagues have been highly reluctant to prescribe to patients over 80 years old. But someone has heard their plea for evidence: in this issue we abstract a large randomised trial of a combined ACE inhibitor and diuretic in patients over 80 years, which shows not only reductions in cardiovascular events and deaths but reduction in all-cause mortality. A practice changing article! While it’s easy to see this result through the retrospectoscope, we are not good at guessing results based on pathophysiological plausibility.
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