title: Modelling of blood pressure and total cardiovascular risk outcomes after second-line valsartan therapy: the BSCORE study.
abstract: BACKGROUND
  European guidelines recommend that antihypertensive management should be graded as a function of total cardiovascular risk.
  
  
  OBJECTIVE
  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.
authors.affiliation: University of Antwerpen, Belgium.
authors.forename: Robert
authors.initials: R
authors.lastname: Lins
authors.forename: Nicolas
authors.initials: N
authors.lastname: Coen
authors.forename: Ann
authors.initials: A
authors.lastname: Aerts
authors.forename: Karen
authors.initials: K
authors.lastname: Macdonald
authors.forename: Heidi
authors.initials: H
authors.lastname: Brié
authors.forename: Christine
authors.initials: C
authors.lastname: Hermans
authors.forename: Yu-Ming
authors.initials: YM
authors.lastname: Shen
authors.forename: Christopher
authors.initials: C
authors.lastname: Lee
authors.forename: Stefaan
authors.initials: S
authors.lastname: Vancayzeele
authors.forename: Natalie
authors.initials: N
authors.lastname: Mecum
authors.forename: Ivo
authors.initials: I
authors.lastname: Abraham
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; 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; D004232:Diuretics; D013777:Tetrazoles; D006852:Hydrochlorothiazide; D000068756:Valsartan; D014633:Valine