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

Robert Lins, Nicolas Coen, Ann Aerts, Karen MacDonald, Heidi Brié, Christine Hermans, Yu Ming Shen, Christopher Lee, Stefaan Vancayzeele, Natalie Mecum, Ivo L Abraham

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)428-434
Number of pages7
JournalArchives of Cardiovascular Diseases
Volume104
Issue number8-9
DOIs
StatePublished - Aug 2011

Fingerprint

Valsartan
Blood Pressure
Physicians
Therapeutics
Antihypertensive Agents
Hydrochlorothiazide

Keywords

  • Angiotensin II type 1
  • Blood pressure
  • Hypertension
  • Receptor blockers
  • Treatment effectiveness
  • Valsartan

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Modelling of blood pressure and total cardiovascular risk outcomes after second-line valsartan therapy : The BSCORE study. / Lins, Robert; Coen, Nicolas; Aerts, Ann; MacDonald, Karen; Brié, Heidi; Hermans, Christine; Shen, Yu Ming; Lee, Christopher; Vancayzeele, Stefaan; Mecum, Natalie; Abraham, Ivo L.

In: Archives of Cardiovascular Diseases, Vol. 104, No. 8-9, 08.2011, p. 428-434.

Research output: Contribution to journalArticle

Lins, R, Coen, N, Aerts, A, MacDonald, K, Brié, H, Hermans, C, Shen, YM, Lee, C, Vancayzeele, S, Mecum, N & Abraham, IL 2011, 'Modelling of blood pressure and total cardiovascular risk outcomes after second-line valsartan therapy: The BSCORE study', Archives of Cardiovascular Diseases, vol. 104, no. 8-9, pp. 428-434. https://doi.org/10.1016/j.acvd.2010.12.005
Lins, Robert ; Coen, Nicolas ; Aerts, Ann ; MacDonald, Karen ; Brié, Heidi ; Hermans, Christine ; Shen, Yu Ming ; Lee, Christopher ; Vancayzeele, Stefaan ; Mecum, Natalie ; Abraham, Ivo L. / Modelling of blood pressure and total cardiovascular risk outcomes after second-line valsartan therapy : The BSCORE study. In: Archives of Cardiovascular Diseases. 2011 ; Vol. 104, No. 8-9. pp. 428-434.
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AU - Brié, Heidi

AU - Hermans, Christine

AU - Shen, Yu Ming

AU - Lee, Christopher

AU - Vancayzeele, Stefaan

AU - Mecum, Natalie

AU - Abraham, Ivo L

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AB - 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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