title: 1-Year outcomes of hypertension management in 13,000 outpatients under practice conditions: prospective 3A registry.
abstract: BACKGROUND
  Current data on characteristics and outcomes of patients with high blood pressure (BP) managed under clinical practice conditions are limited.
  
  
  RESULTS
  The 3A registry is an open, prospective observational cohort study in German primary care offices, with a 4:1:1 inclusion ratio to either aliskiren (ALIS), an ACE inhibitor/angiotensin receptor blocker (ACEI/ARB), or to an antihypertensive agent not affecting the renin angiotensin system (non-RAS). A nonlinear mixed regression model was used to assess BP changes during follow-up regarding different BP values at inclusion in the various groups. ClinicalTrial.gov identifier is NCT01454583. In the total cohort of 13,433 patients with 1-year follow-up results, the mean age of patients was 64.7 years, 54% were men. Mean number of antihypertensive drugs was higher in the ALIS group compared to the other groups (3.0 drugs versus 2.5 in ACEI/ARB versus 1.6 in non-RAS; p<0.0001). Statistical regression analysis revealed baseline BP as the dominant covariate. After adjustment for baseline BP and 12 other confounders, no significant differences in BP reduction between the three groups were observed. The rate of major cardiac events (death, myocardial infarction, and stroke) was 1.3% in the total cohort, and did not differ across groups.
  
  
  CONCLUSIONS
  ALIS at beginning of the observation was mostly used by the physicians in patients with higher BP at entry and in higher risk populations. By study end, in all groups, stringent BP lowering measures, usually with combination therapy, led to significant improvements; more than half of these at-risk patients reached the BP targets.
authors.affiliation: Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany; Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany. Electronic address: Uwe.Zeymer@t-online.de.
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.affiliation: Helios-Klinikum Berlin-Buch, Berlin, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Dechend
authors.affiliation: Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Riemer
authors.affiliation: Novartis Pharma GmbH, Nürnberg, Germany.
authors.forename: Edelgard
authors.initials: E
authors.lastname: Kaiser
authors.affiliation: Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.affiliation: Institute for Clinical Pharmacology, Medical Faculty, Technical University of Dresden, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Pittrow
authors.affiliation: Department of Nephrology and Hypertension, University Hospital, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
mesh_terms: D000368:Aged; D000577:Amides / Q000627:therapeutic use*; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D005260:Female; D005650:Fumarates / Q000627:therapeutic use*; D005858:Germany; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome
chemical_list: D000577:Amides; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D005650:Fumarates; C446481:aliskiren
keywords: Clinical practice; Control rates; Effectiveness; Essential hypertension; Long-term; Management; Outcomes; Renin angiotensin system