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    
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.
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
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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    
aCentro Interuniversitario di Fisiologia Clinica e Ipertensione, University of Milan, Istituto Auxologico Italiano and Ospedale Maggiore, Milan, Italy.
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MeSH Terms
Amlodipine / therapeutic use*
Angiotensin II Type 1 Receptor Blockers / therapeutic use*
Calcium Channel Blockers / therapeutic use*
Heart Arrest / mortality,  prevention & control*
Heart Failure / mortality,  prevention & control*
Hypertension / complications,  drug therapy*
Middle Aged
Proportional Hazards Models
Sex Factors
Tetrazoles / therapeutic use*
Treatment Outcome
Valine / analogs & derivatives*,  therapeutic use
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

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