Effectiveness of Valsartan for Treatment of Hypertension: Patient Profiling and Hierarchical Modeling of Determinants and Outcomes (the Preview Study)

Author:

Niepen Patricia Van Der1,Woestenburg Annemie2,Brié Heidi3,Vancayzeele Stefaan4,Macdonald Karen5,Denhaerynck Kris6,Lee Christopher7,Hermans Christine8,Abraham Ivo9

Affiliation:

1. Tutor in Internal Medicine, Department of Nephrology and Hypertension, Universitair Ziekenhuis Brussel, Brussel, Belgium

2. Department of Nephrology and Hypertension, Universitair Ziekenhuis Brussel

3. Manager of Medical Affairs, Department of Medical Affairs, Novartis Pharma, Vilvoorde, Belgium

4. Medical Director, Department of Medical Affairs, Novartis Pharma, Vilvoorde

5. Matrix45, Earlysville, VA

6. Matrix45, Basel, Switzerland; Research Associate, Universitaetspital Basel, Division of Cardiology, Basel

7. Matrix45, Philadelphia, PA; Lecturer, School of Nursing, University of Pennsylvania, Philadelphia

8. Department of Medical Affairs, Novartis Pharma, Vilvoorde

9. Matrix45, Earlysville; Professor, College of Nursing, University of Arizona, Tucson, AZ; Professor, College of Pharmacy and Investigator, Center for Health Outcomes and PharmacoEconomic Research, Tucson

Abstract

Background Patient- and clinician-related factors may explain variability in blood pressure (BP) outcomes and the differences between real-world effectiveness and efficacy seen in randomized trials of antihypertensive agents. Objective To examine the effectiveness of 90 days of second-line valsartan treatment and identify patient- and physician-level determinants that impact BP outcomes. Methods A prospective, multicenter, multilevel pharmacoepidemiologic study was conducted in 3194 hypertensive patients (systolic BP [SBP] ≥140 mm Hg, diastolic BP [DBP] ≥90 mm Hg; for diabetic patients, ≥130 and ≥80 mm Hg, respectively) treated by 504 general practitioners (GPs). Statistical analysis included heuristic data mining, and hierarchical linear and logistic modeling. Results With valsartan treatment, mean ± SD SBP decreased from 154.4 ± 15.5 mm Hg to 139.0 ± 12.0 mm Hg and mean DBP decreased from 91.3 ± 9.2 mm Hg to 82.6 ± 7.4 mm Hg. SBP control rates increased from 9.0% to 38.6%, DBP from 25.5% to 65.5%, and combined SBP/DBP from 7.3% to 34.4%. A highly vulnerable cohort (n = 1063;35.4%) of patients was identified. Twenty-four percent of variability in SBP and 25% of variability in DBP at 90 days were attributable to physician-related variables: guideline-compliant BP management, hypertension, practice patterns, hypertensive patient volume, and years in practice. The remaining 76% and 75% of variability in SBP and DBP, respectively, were due to patient factors, notably diabetes and related complications, vulnerability to uncontrolled BP, nonadherence, cardiovascular risk, and age. Simitar factors increased the odds of treatment nonresponse, with diabetes being the single largest determinant of uncontrolled SBP (OR 8.99), DBP (OR 20.35), and combined SBP/DBP (OR = 18.64). Conclusions Valsartan is effective and well tolerated in a broad range of patients in whom first-line antihypertensive treatment failed or was not tolerated. Mitigating the impact of BP-elevating variables and optimizing the effect of BP-lowering factors provides therapeutic benefits incremental to valsartan's pharmacologic effect. Improving outcomes in hypertensive patients involves 3 steps: (1) identifying, intuitively rather than formally, patients less likely to achieve BP control; (2) targeting modifiable or manageable patient- and physician-level determinants with BP-elevating or BP-lowering effects; and (3) managing variables that increase the odds and optimizing those that lower the odds of uncontrolled BP.

Publisher

SAGE Publications

Subject

Pharmacology (medical)

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3