title: Modelling of blood pressure outcomes in patients with and without established cardiovascular or renal disease following treatment with valsartan (the PREVIEW study).
abstract: BACKGROUND
  Hypertensive patients with established cardiovascular or renal disease (ECVRD) have an added 10-year risk of cardiovascular events, classified by the European Society of Hypertension/European Society of Cardiology as 'very high'.
  
  
  OBJECTIVE
  To identify determinants of blood pressure (BP) outcomes in hypertensive patients with and without ECVRD treated in second-line with valsartan.
  
  
  METHODS
  This was a subgroup analysis comparing patients with and without ECVRD who participated in the PREVIEW study, a 90-day observational prospective effectiveness study of valsartan, conducted in Belgium. Two-level (patients 'nested' under physicians) hierarchical linear and logistic modelling of BP values and BP control (140/90 mmHg; 130/80 mmHg for diabetics) at 90 days was applied to data from 1107 patients with and 2087 patients without ECVRD treated with valsartan by 504 general practitioners.
  
  
  RESULTS
  Absolute reductions in BP were similar across subgroups, with minor variations in actual BP levels in general and by subgroup. Fewer patients with versus without ECVRD achieved targets for systolic BP, diastolic BP and combined systolic/diastolic BP control. Variability in BP values and control at 90 days attributable to a physician-level class effect ranged from 24.6% to 28.1% and 15.0% to 22.4%, respectively. Physician- and patient-related determinants of 90-day BP outcomes varied considerably between the two subgroups.
  
  
  CONCLUSIONS
  Several determinants of BP outcomes were identified comparing patients with and without ECVRD, including amenable physician-level and patient-level factors and warning signs for continued risk of uncontrolled BP. ECVRD patients present with differential characteristics, conditions and determinants that mandate individualized attention to complement general evidence-based antihypertensive treatment.
authors.affiliation: Matrix45, Tucson, AZ, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Macdonald
authors.forename: Heidi
authors.initials: H
authors.lastname: Brié
authors.forename: Stefaan
authors.initials: S
authors.lastname: Vancayzeele
authors.forename: Christopher
authors.initials: C
authors.lastname: Lee
authors.forename: John
authors.initials: J
authors.lastname: Bowles
authors.forename: Kathleen
authors.initials: K
authors.lastname: Piotrowski
authors.forename: Christine
authors.initials: C
authors.lastname: Hermans
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*; D001530:Belgium / Q000453:epidemiology; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology*; D016009:Chi-Square Distribution; D057186:Comparative Effectiveness Research; D005260:Female; D058006:General Practice; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D007674:Kidney Diseases / Q000453:epidemiology / 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; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine