Document Detail


Outcomes in subgroups of hypertensive patients treated with regimens based on valsartan and amlodipine: An analysis of findings from the VALUE trial.
MedLine Citation:
PMID:  17053536     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial the primary outcome (cardiac morbidity and mortality) did not differ between valsartan and amlodipine-based treatment groups, although systolic blood pressure (SBP) and diastolic blood pressure reductions were significantly more pronounced with amlodipine. Stroke incidence was non-significantly, and myocardial infarction was significantly lower in the amlodipine-based regimen, whereas cardiac failure was non-significantly lower on valsartan. OBJECTIVES: The study protocol specified additional analyses of the primary endpoint according to: sex; age; race; geographical region; smoking status; type 2 diabetes; total cholesterol; left ventricular hypertrophy; proteinuria; serum creatinine; a history of coronary heart disease; a history of stroke or transient ischemic attack; and a history of peripheral artery disease. Additional subgroups were isolated systolic hypertension and classes of antihypertensive agents used immediately before randomization. METHODS: The 15,245 hypertensive patients participating in VALUE were divided into subgroups according to baseline characteristics. Treatment by subgroup interaction analyses were carried out by a Cox proportional hazard model. Within each subgroup, treatment effects were assessed by hazard ratios and 95% confidence intervals. RESULTS: For cardiac mortality and morbidity, the only significant subgroup by treatment interaction was of sex (P = 0.016), with the hazard ratio indicating a relative excess of cardiac events with valsartan treatment in women but not in men, but SBP differences in favour of amlodipine were distinctly greater in women. No other subgroup showed a significant difference in the composite cardiac outcome between valsartan and amlodipine-based treatments. For secondary endpoints, a sex-related significant interaction was found for heart failure (P < 0.0001), with men but not women having a lower incidence of heart failure with valsartan. CONCLUSION: As in the whole VALUE cohort, in no subgroup of patients were there differences in the incidence of the composite cardiac endpoint with valsartan and amlodipine-based treatments, despite a greater blood pressure decrease in the amlodipine group. The only exception was sex, in which the amlodipine-based regimen was more effective than valsartan in women, but not in men, whereas the valsartan regimen was more effective in preventing cardiac failure in men than in women.
Authors:
Alberto Zanchetti; Stevo Julius; Sverre Kjeldsen; Gordon T McInnes; Tsushung Hua; Michael Weber; John H Laragh; Francis Plat; Edouard Battegay; Cesar Calvo-Vargas; Andrzej Cieśliński; Jean Paul Degaute; Nicolaas J Holwerda; Janna Kobalava; Ole Lederballe Pedersen; Faustinus P Rudyatmoko; Kostas C Siamopoulos; Oyvind Störset
Related Documents :
1407916 - Effects of methyldopa on umbilical and placental artery blood flow velocity waveforms.
3874536 - The association of intakes of vitamin d and calcium with blood pressure among women.
2856746 - Blood pressure changes over 20 years in nuns in a secluded order.
20857796 - Safety, efficacy and acceptability of implanon a single rod implantable contraceptive (...
2063776 - Older age and elevated blood pressure are risk factors for intracerebral hemorrhage aft...
19734796 - Endoscopic ultrasonography and portal hypertension: where are we in 2009?
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of hypertension     Volume:  24     ISSN:  0263-6352     ISO Abbreviation:  J. Hypertens.     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-10-20     Completed Date:  2006-11-30     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8306882     Medline TA:  J Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  2163-8     Citation Subset:  IM    
Affiliation:
aCentro Interuniversitario di Fisiologia Clinica e Ipertensione, University of Milan, Istituto Auxologico Italiano and Ospedale Maggiore, Milan, Italy. alberto.zanchetti@unimi.it
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Amlodipine / therapeutic use*
Angiotensin II Type 1 Receptor Blockers / therapeutic use*
Calcium Channel Blockers / therapeutic use*
Female
Heart Arrest / mortality,  prevention & control*
Heart Failure / mortality,  prevention & control*
Humans
Hypertension / complications,  drug therapy*
Male
Middle Aged
Proportional Hazards Models
Sex Factors
Tetrazoles / therapeutic use*
Treatment Outcome
Valine / analogs & derivatives*,  therapeutic use
Chemical
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Calcium Channel Blockers; 0/Tetrazoles; 137862-53-4/valsartan; 7004-03-7/Valine; 88150-42-9/Amlodipine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  How strong is the evidence for use of beta-blockers as first-line therapy for hypertension? Systemat...
Next Document:  Prevalence and management of hypertension among Turkish, Moroccan and native Dutch ethnic groups in ...