title: Effect of eprosartan-based antihypertensive therapy on coronary heart disease risk assessed by Framingham methodology in Canadian patients with diabetes: results of the POWER survey.
abstract: OBJECTIVE
  As part of the Physicians' Observational Work on Patient Education According to their Vascular Risk (POWER) survey, we used Framingham methodology to examine the effect of an eprosartan-based regimen on total coronary heart disease (CHD) risk in diabetic patients recruited in Canada.
  
  
  METHODS
  Patients with new or uncontrolled hypertension (sitting systolic blood pressure [SBP] >140 mmHg with diastolic blood pressure <110 mmHg) were identified at 335 Canadian primary care practices. Initial treatment consisted of eprosartan 600 mg/day, which was later supplemented with other antihypertensives as required. Outcomes included change in SBP at 6 months (primary objective) and absolute change in the Framingham 10-year CHD risk score (secondary objective).
  
  
  RESULTS
  We identified an intention-to-treat diabetes population of 195 patients. Most diabetic patients were prescribed two or more antihypertensive drugs throughout the survey. Mean reductions in SBP and diastolic blood pressure were 20.8±14.8 mmHg and 9.5±10.7 mmHg, respectively. The overall absolute mean 10-year CHD risk, calculated using Framingham formulae, declined by 2.9±3.5 points (n=49). Average baseline risk was higher in men than women (14.8±8.6 versus 5.6±1.8 points); men also had a larger average risk reduction (4.2±4.3 versus 1.5±1.3 points). The extent of absolute risk reduction also increased with increasing age (trend not statistically significant).
  
  
  CONCLUSIONS
  Eprosartan-based therapy substantially reduced arterial blood pressure in our subset of diabetic patients; while there was a slight reduction in Framingham risk, there are indications from our data that both blood pressure control and the wider management of CHD risk in diabetic patients remains suboptimal in Canadian primary care.
authors.affiliation: Departments of Family Medicine, Medicine (Cardiology) and Kinesiology, University of Western Ontario, London, ON, Canada ; Aging, Rehabilitation and Geriatric Care Research Centre, Lawson Health Research Institute, London, ON, Canada ; Department of Family Medicine and School of Health Studies, University of Western Ontario, London, ON, Canada.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Petrella
authors.affiliation: Aging, Rehabilitation and Geriatric Care Research Centre, Lawson Health Research Institute, London, ON, Canada ; Department of Family Medicine and School of Health Studies, University of Western Ontario, London, ON, Canada.
authors.forename: Dawn P
authors.initials: DP
authors.lastname: Gill
authors.affiliation: Abbott Products Operations AG, Allschwil, Switzerland.
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Berrou
keywords: Framingham; cardiovascular risk; diabetes; eprosartan; hypertension
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