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Title
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Modelling of blood pressure and total cardiovascular risk outcomes after second-line valsartan therapy : the BSCORE study
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Author
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Abstract
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| 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. |
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Language
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English
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Source (journal)
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Archives of cardiovascular diseases. - Paris, 2008, currens
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Publication
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Paris
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2011
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ISSN
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1875-2136
[print]
1875-2128
[online]
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DOI
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10.1016/J.ACVD.2010.12.005
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Volume/pages
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104
:8/9
(2011)
, p. 428-434
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ISI
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000296940600002
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Full text (Publisher's DOI)
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Full text (open access)
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