TY - JOUR
T1 - Modelling of blood pressure outcomes in patients with and without established cardiovascular or renal disease following treatment with valsartan (the PREVIEW study)
AU - MacDonald, Karen
AU - Brié, Heidi
AU - Vancayzeele, Stefaan
AU - Lee, Christopher
AU - Bowles, John
AU - Piotrowski, Kathleen
AU - Hermans, Christine
AU - Abraham, Ivo
N1 - Funding Information:
Ivo Abraham was supported in part as the Director of the Arizona Postdoctoral/Academic Fellowship Program in Clinical Outcomes and Comparative Effectiveness Research in Primary Care, funded by the Bureau of Health Professions, US Department of Health and Human Services . Christopher Lee was supported in part by a postdoctoral fellowship in cardiovascular clinical outcomes and effectiveness research at the University of Arizona, funded by Matrix45 .
Funding Information:
The PREVIEW study was supported by grants and contracts from Novartis Pharma . The work reported here was outside the scope of this prior support and authors contributed pro bono. Any issues related to results or manuscripts were addressed by the external authors. The sponsor had right to review and comment.
PY - 2013/3
Y1 - 2013/3
N2 - Background: Hypertensive patients with established cardiovascular or renal disease (ECVRD) have an added 10-year risk of cardiovascular events, classified by the European Society of Hypertension/European Society of Cardiology as 'very high'. Aims: To identify determinants of blood pressure (BP) outcomes in hypertensive patients with and without ECVRD treated in second-line with valsartan. Methods: This was a subgroup analysis comparing patients with and without ECVRD who participated in the PREVIEW study, a 90-day observational prospective effectiveness study of valsartan, conducted in Belgium. Two-level (patients 'nested' under physicians) hierarchical linear and logistic modelling of BP values and BP control (140/90 mmHg; 130/80 mmHg for diabetics) at 90 days was applied to data from 1107 patients with and 2087 patients without ECVRD treated with valsartan by 504 general practitioners. Results: Absolute reductions in BP were similar across subgroups, with minor variations in actual BP levels in general and by subgroup. Fewer patients with versus without ECVRD achieved targets for systolic BP, diastolic BP and combined systolic/diastolic BP control. Variability in BP values and control at 90 days attributable to a physician-level class effect ranged from 24.6% to 28.1% and 15.0% to 22.4%, respectively. Physician- and patient-related determinants of 90-day BP outcomes varied considerably between the two subgroups. Conclusion: Several determinants of BP outcomes were identified comparing patients with and without ECVRD, including amenable physician-level and patient-level factors and warning signs for continued risk of uncontrolled BP. ECVRD patients present with differential characteristics, conditions and determinants that mandate individualized attention to complement general evidence-based antihypertensive treatment.
AB - Background: Hypertensive patients with established cardiovascular or renal disease (ECVRD) have an added 10-year risk of cardiovascular events, classified by the European Society of Hypertension/European Society of Cardiology as 'very high'. Aims: To identify determinants of blood pressure (BP) outcomes in hypertensive patients with and without ECVRD treated in second-line with valsartan. Methods: This was a subgroup analysis comparing patients with and without ECVRD who participated in the PREVIEW study, a 90-day observational prospective effectiveness study of valsartan, conducted in Belgium. Two-level (patients 'nested' under physicians) hierarchical linear and logistic modelling of BP values and BP control (140/90 mmHg; 130/80 mmHg for diabetics) at 90 days was applied to data from 1107 patients with and 2087 patients without ECVRD treated with valsartan by 504 general practitioners. Results: Absolute reductions in BP were similar across subgroups, with minor variations in actual BP levels in general and by subgroup. Fewer patients with versus without ECVRD achieved targets for systolic BP, diastolic BP and combined systolic/diastolic BP control. Variability in BP values and control at 90 days attributable to a physician-level class effect ranged from 24.6% to 28.1% and 15.0% to 22.4%, respectively. Physician- and patient-related determinants of 90-day BP outcomes varied considerably between the two subgroups. Conclusion: Several determinants of BP outcomes were identified comparing patients with and without ECVRD, including amenable physician-level and patient-level factors and warning signs for continued risk of uncontrolled BP. ECVRD patients present with differential characteristics, conditions and determinants that mandate individualized attention to complement general evidence-based antihypertensive treatment.
KW - Cardiovascular disease
KW - Effectiveness
KW - Hypertension
KW - Renal disease
KW - Valsartan
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U2 - 10.1016/j.acvd.2012.11.006
DO - 10.1016/j.acvd.2012.11.006
M3 - Article
C2 - 23582674
AN - SCOPUS:84876287177
SN - 1875-2136
VL - 106
SP - 124
EP - 134
JO - Archives of Cardiovascular Diseases
JF - Archives of Cardiovascular Diseases
IS - 3
ER -