Blood Pressure Goals and Treatment
Algorithms Can Improve BP Control
When an explicit blood pressure (BP) goal
is set and a treatment algorithm is provided,
physicians can achieve better control rates than
in regular practice.
The VALUE study is an ongoing trial comparing
cardiovascular outcomes in 15,314 eligible patients
from 31 countries. Specifically, the study investigates
whether lowering BP with the angiotensin-receptor
blocker valsartan (Diovan; Novartis, Basel, Switzerland)
yields better cardiovascular outcomes than treatment
with the calcium antagonist amlodipine (Norvasc;
Pfizer, New York, New York).
Stevo Julius, MD, with the University of Michigan
Health System, Ann Arbor, Michigan, and colleagues
analyzed the BP trends in 13,449 VALUE study patients
who had baseline and 24-month BP and treatment
data.
Of the patients, 92% received antihypertensive
therapy at baseline. Baseline BP was 153.5/86.9
mm Hg in treated patients compared to 168.1.8/95.3
mm Hg in untreated patients.
After 6 months, both groups had indistinguishable
BP values, which decreased in both groups significantly
at 12, 24, and 30 months (P< 0.0001 versus
previous measurement for all values).
Of the patients, 21.9% had systolic BP control
(<140 mm Hg) at baseline, which increased to
62.2% at 30 months, while 54.2% had diastolic
BP control (<90 mm Hg) at baseline, which increased
to 90.2%; likewise, the proportion of patients
with combined control (<140 and <90 mm Hg)
increased from 18.9% to 60.5%.
At 24 months, 85.8% of patients were on protocol
drugs: monotherapy 39.7%, added hydrochlorothiazide
26.6%, add-on drugs 15.1%, and protocol drugs
in non-standard doses 4.3%.
"Despite considerable improvement of BP
management in the VALUE study our 24 and 30 months
of BP outcome is still not ideal," the researchers
note. "However, the results reported herein
are substantially better than in most published
studies," they add.
According to Dr. Julius and colleagues, the findings
imply that organizational and educational efforts
to improve systolic BP control can be effective.
"Our BP-lowering initiative has been well
received by the study physicians and BP in the
study continues decreasing," they suggest.
"We believe that setting a fixed stepwise
algorithm of drug usage was an important component
in the improvement of BP control in the VALUE
study."
Data from the Valsartan Antihypertensive Long-term
Use Evaluation (VALUE) Study
Am J Hypertens 2003;16:7:544-548.
