Modelling of blood pressure and total cardiovascular risk outcomes after second-line valsartan therapy: The BSCORE study
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...
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Published in | Archives of cardiovascular diseases Vol. 104; no. 8; pp. 428 - 434 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Amsterdam
Elsevier Masson SAS
01.08.2011
Elsevier |
Subjects | |
Online Access | Get full text |
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Summary: | 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. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 1875-2136 1875-2128 |
DOI: | 10.1016/j.acvd.2010.12.005 |