Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA.
College of Pharmacy, Al-Zaytoona University of Jordan, Amman, Jordan.
Curr Med Res Opin. 2021 Jan;37(1):1-8. doi: 10.1080/03007995.2020.1853082. Epub 2020 Dec 11.
Six prospective real-world studies of antihypertensive treatment with valsartan-centric regimens were pooled to: (1) examine the effectiveness of ∼90 days of second- or later-line valsartan treatment in hypertensive patients with known comorbidities; and (2) identify physician- and patient-related determinants associated with systolic (SBP) and diastolic blood pressure (DBP) outcomes in these patients.
A pooled analysis was performed of an evaluable sample of 11,999 hypertensive patients with known comorbidities treated ∼90 days with valsartan-centric regimens. We applied hierarchical linear and logistic regression models to identify determinants of blood pressure (BP) outcomes and a potential physician class effect.
Valsartan regimens resulted in mean (SD) SBP and DBP reductions of 18.0 (15.8) mmHg and 9.5 (10.1) mmHg, respectively, at ∼90 days, yielding SBP, DBP and combined SBP/DBP control rates of 44.0%, 67.2% and 39.3%, respectively. About a quarter of the variance in 90 day BP values was attributable to a physician class effect. BP outcomes declined with physicians' increasing years in practice and being male. At the patient level, BP outcomes declined with SBP and DBP at diagnosis; diabetes; higher cholesterol and BMI; lower valsartan and hydrochlorothiazide (HCTZ) doses; and concomitant anti-hypertensives. Older age was associated with improved DBP. A proxy of physician vigilance, cardiovascular disease history, was associated with improved BP outcomes, as were patient adherence and higher doses of valsartan in combination with HCTZ.
Valsartan-centric regimens have significant BP lowering benefits in this pooled sample of patients with known comorbidities. Many observed determinants of BP outcomes are modifiable or manageable.
汇总了六项前瞻性真实世界的抗高血压治疗研究，旨在：（1）评估在已知合并症的高血压患者中，使用缬沙坦为基础的方案治疗约 90 天的二线或后续缬沙坦治疗的有效性；（2）确定与这些患者的收缩压（SBP）和舒张压（DBP）结果相关的医生和患者相关决定因素。
对 11999 例已知合并症的高血压患者进行了可评估样本的汇总分析，这些患者接受了约 90 天的缬沙坦为基础的方案治疗。我们应用分层线性和逻辑回归模型来确定血压（BP）结果的决定因素和潜在的医生类别效应。
缬沙坦方案在约 90 天时使 SBP 和 DBP 分别降低 18.0（15.8）mmHg 和 9.5（10.1）mmHg，SBP、DBP 和联合 SBP/DBP 的控制率分别为 44.0%、67.2%和 39.3%。90 天 BP 值的约四分之一可归因于医生类别效应。BP 结果随医生从业年限的增加和男性而下降。在患者层面，BP 结果随诊断时的 SBP 和 DBP、糖尿病、更高的胆固醇和 BMI、更低的缬沙坦和氢氯噻嗪（HCTZ）剂量以及同时使用的抗高血压药物而下降。年龄较大与 DBP 的改善相关。医生警觉性的一个代理指标，即心血管疾病病史，与改善的 BP 结果相关，患者的依从性和 HCTZ 联合使用更高剂量的缬沙坦也是如此。
在已知合并症的患者中，缬沙坦为基础的方案具有显著的降压益处。许多观察到的 BP 结果决定因素是可改变或可管理的。
