Issue 167 Item 5 Blood Pressure Goals and Treatment Algorithms Can Improve BP Co

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.