TY - JOUR
T1 - Modelling of blood pressure and total cardiovascular risk outcomes after second-line valsartan therapy
T2 - The BSCORE study
AU - Lins, Robert
AU - Coen, Nicolas
AU - Aerts, Ann
AU - MacDonald, Karen
AU - Brié, Heidi
AU - Hermans, Christine
AU - Shen, Yu Ming
AU - Lee, Christopher
AU - Vancayzeele, Stefaan
AU - Mecum, Natalie
AU - Abraham, Ivo
N1 - Funding Information:
This study was sponsored by Novartis Pharma.
PY - 2011/8
Y1 - 2011/8
N2 - Background: European guidelines recommend that antihypertensive management should be graded as a function of total cardiovascular risk. Aims: To examine the multilevel (patient- and physician-level) determinants of blood pressure and residual total cardiovascular risk outcomes associated with second-line valsartan therapy. Methods: The BSCORE study was a prospective, multi-centre, pharmacoepidemiological study of the "real-world" effectiveness of second-line valsartan with or without hydrochlorothiazide. Results: A total of 3497 patients were recruited by 354 physicians. Mean age was 63.8 ± 12.0 years; 52.3% were male; 20.9% were smokers; 47.7% were dyslipidaemic; and 23.6% had diabetes. On average, reductions in blood pressure and increases in the proportions of patients with controlled blood pressure after 90 days were statistically significant (all P < 0.001). Twenty-one percent of systolic blood pressure and 25.6% of diastolic blood pressure variability at follow-up was attributable to physician-level characteristics. Significant reductions in total cardiovascular risk were observed (P < 0.001); with 12.5% of the variability in total cardiovascular risk change attributable to physician-level characteristics. Several independent determinants of blood pressure outcomes were identified, many of which are modifiable. Conclusions: Second-line valsartan therapy improves blood pressure outcomes under variable real-world conditions, and is associated with a decrease in total cardiovascular risk. Optimizing antihypertensive effectiveness, including the reduction of residual cardiovascular risk, involves managing concomitant conditions and risk factors, improving adherence, and identifying physician-level factors amenable to intervention.
AB - Background: European guidelines recommend that antihypertensive management should be graded as a function of total cardiovascular risk. Aims: To examine the multilevel (patient- and physician-level) determinants of blood pressure and residual total cardiovascular risk outcomes associated with second-line valsartan therapy. Methods: The BSCORE study was a prospective, multi-centre, pharmacoepidemiological study of the "real-world" effectiveness of second-line valsartan with or without hydrochlorothiazide. Results: A total of 3497 patients were recruited by 354 physicians. Mean age was 63.8 ± 12.0 years; 52.3% were male; 20.9% were smokers; 47.7% were dyslipidaemic; and 23.6% had diabetes. On average, reductions in blood pressure and increases in the proportions of patients with controlled blood pressure after 90 days were statistically significant (all P < 0.001). Twenty-one percent of systolic blood pressure and 25.6% of diastolic blood pressure variability at follow-up was attributable to physician-level characteristics. Significant reductions in total cardiovascular risk were observed (P < 0.001); with 12.5% of the variability in total cardiovascular risk change attributable to physician-level characteristics. Several independent determinants of blood pressure outcomes were identified, many of which are modifiable. Conclusions: Second-line valsartan therapy improves blood pressure outcomes under variable real-world conditions, and is associated with a decrease in total cardiovascular risk. Optimizing antihypertensive effectiveness, including the reduction of residual cardiovascular risk, involves managing concomitant conditions and risk factors, improving adherence, and identifying physician-level factors amenable to intervention.
KW - Angiotensin II type 1
KW - Blood pressure
KW - Hypertension
KW - Receptor blockers
KW - Treatment effectiveness
KW - Valsartan
UR - http://www.scopus.com/inward/record.url?scp=80053213963&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=80053213963&partnerID=8YFLogxK
U2 - 10.1016/j.acvd.2010.12.005
DO - 10.1016/j.acvd.2010.12.005
M3 - Article
C2 - 21944144
AN - SCOPUS:80053213963
SN - 1875-2136
VL - 104
SP - 428
EP - 434
JO - Archives of Cardiovascular Diseases
JF - Archives of Cardiovascular Diseases
IS - 8-9
ER -