title: Patient- and physician-level determinants of blood pressure response to treatment in normal weight and overweight patients (the PREVIEW study).
abstract: OBJECTIVE
  Obesity combined with hypertension places patients at greater risk for target-organ damage and cardiovascular disease. The purpose of this secondary analysis was to identify physician- and patient-levels determinants of blood pressure (BP) values and predictors of uncontrolled BP through subgroup analysis by body mass index (BMI).
  
  
  RESULTS
  We conducted a subgroup analysis of 3006 patients with High-BMI (BMI >25 kg/m(2); n=2124) and Normal-BMI (BMI<25 kg/m(2); n=882) treated by 504 physicians and enrolled in PREVIEW, a Belgian prospective, multi-center, pharmaco-epidemiological study of 90-day second-line treatment with valsartan. Physician- and patient-level determinants of BP values and BP control were identified by means of hierarchical linear and logistic regression. Blood pressure values and control after 90 days of treatment were consistently lower for the High-BMI group. The 25.5% of variance in 90-day systolic and 28.3% of the variance in 90-day diastolic BP were attributable to physician-level determinants for the High-BMI group; versus 27.3% and 29.8% for the Normal-BMI group (ICC=0.273 and 0.298, respectively). Determinants of 90-day BP values and predictors of uncontrolled BP varied considerably by BMI status.
  
  
  CONCLUSIONS
  Several common and unique patient- and physician-level determinants of BP values and control were identified for the High-BMI and Normal-BMI groups. These findings highlight the need for differentiating healthcare interventions to account for patient and physician variables, particularly with respect to effective BP management in vulnerable populations.
authors.affiliation: Center for Health Outcomes and PharmacoEconomic Research, and Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, 1295 N. Martin, Tucson, AZ 85721, USA. abraham@pharmacy.arizona.edu
authors.forename: I
authors.initials: I
authors.lastname: Abraham
authors.forename: K
authors.initials: K
authors.lastname: MacDonald
authors.forename: M
authors.initials: M
authors.lastname: Song
authors.forename: G
authors.initials: G
authors.lastname: Ciesielski
authors.forename: C
authors.initials: C
authors.lastname: Pacheco
authors.forename: C
authors.initials: C
authors.lastname: Lee
authors.forename: M
authors.initials: M
authors.lastname: Cholette
authors.forename: K
authors.initials: K
authors.lastname: Kinsey
authors.forename: P
authors.initials: P
authors.lastname: Speaks
authors.forename: C
authors.initials: C
authors.lastname: Hermans
authors.forename: H
authors.initials: H
authors.lastname: Brié
authors.forename: S
authors.initials: S
authors.lastname: Reel
authors.forename: P
authors.initials: P
authors.lastname: Van der Niepen
authors.forename: B
authors.initials: B
authors.lastname: Yee
authors.forename: S
authors.initials: S
authors.lastname: Vancayzeele
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001530:Belgium; D001794:Blood Pressure / Q000187:drug effects*; D015992:Body Mass Index; D001835:Body Weight; D002983:Clinical Competence; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D016017:Odds Ratio; D050177:Overweight / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012307:Risk Factors; D013777:Tetrazoles / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine