Modelling of blood pressure and total cardiovascular risk outcomes after second-line valsartan therapy: The BSCORE study

• Published in: Archives of cardiovascular diseases Vol. 104; no. 8; pp. 428 - 434
• Main Authors: Lins, Robert, Coen, Nicolas, Aerts, Ann, MacDonald, Karen, Brié, Heidi, Hermans, Christine, Shen, Yu-Ming, Lee, Christopher, Vancayzeele, Stefaan, Mecum, Natalie, Abraham, Ivo
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Masson SAS 01.08.2011; Elsevier
• Subjects: Aged; Angiotensin II type 1; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Antihypertensive Agents - therapeutic use; Arterial hypertension. Arterial hypotension; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Blood pressure; Blood Pressure - drug effects; Cardiology. Vascular system; Cardiovascular; Cardiovascular Diseases - etiology; Cardiovascular Diseases - physiopathology; Cardiovascular Diseases - prevention & control; Diuretics - therapeutic use; Dresseurs de récepteur de type 1 de l’angiotensine II; Drug Therapy, Combination; Efficacité de traitement; Female; Humans; Hydrochlorothiazide - therapeutic use; Hypertension; Hypertension - complications; Hypertension - drug therapy; Hypertension - physiopathology; Internal Medicine; Linear Models; Logistic Models; Male; Medical sciences; Middle Aged; Odds Ratio; Prospective Studies; Receptor blockers; Risk Assessment; Risk Factors; Tension artérielle; Tetrazoles - therapeutic use; Time Factors; Treatment effectiveness; Treatment Outcome; Valine - analogs & derivatives; Valine - therapeutic use; Valsartan; general practitioner; SCORE; Valsartan; European Society of Hypertension; odds ratio; Receptor blockers; TCVR; systolic blood pressure; BP; SD; DBP; Efficacité de traitement; diastolic blood pressure; ESC; intraclass correlation coefficient; Blood pressure; ESH; Tension artérielle; Hypertension; SBP; OR; Dresseurs de récepteur de type 1 de l’angiotensine II; ICC; GP; Systematic COronary Risk Evaluation; Treatment effectiveness; European Society of Cardiology; Angiotensin II type 1; standard deviation; total cardiovascular risk; Prognosis; Treatment efficiency; Cardiovascular disease; Modeling; Vascular disease; Treatment; Angiotensin; Atherosclerosis; Risk factor; Total; Arterial pressure; Tension; Cardiology
• ISSN: 1875-2136; 1875-2128
• DOI: 10.1016/j.acvd.2010.12.005

Summary 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.