Open AccessDeterminants of Achieving Early Blood Pressure Control with Monotherapy in a Primary Care Setting
Author(s) -
Stewart Simon,
Carrington Melinda J.,
Swemmer Carla H.,
Kurstjens Nicol P.,
Brown Alex,
Burrell Louise M.,
Nelson Mark,
Stocks Nigel P.,
Jennings Garry L.
Publication year - 2013
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/jch.12164
Subject(s) - medicine , blood pressure , confidence interval , odds ratio , valsartan , clinical endpoint , primary care , randomized controlled trial , family medicine
This study sought to identify the determinants of early blood pressure ( BP ) control associated with monotherapy in hypertensive individuals being managed in the primary care setting. The V alsartan Intensified Primary Care Reduction of Blood Pressure ( VIPER ‐ BP ) study, was a multicenter, randomized controlled trial of an intensive approach to BP management. During a standardized run‐in, 2185 participants commenced monotherapy (valsartan 80 mg/d) for 14 to 28 days. A total of 1978 participants aged 59±12 years (60% men) completed the run‐in phase. Of these, 15.1%, 43.5%, and 41.4% participants had an initial BP target of ≤125/75, 130/80, and 140/90 mm Hg, respectively. A total of 416 of 2185 participants (19.0%) subsequently achieved their individual BP target during run‐in with a mean BP change of −22.6±12.1/−12.9±8.2 mm Hg vs −4.2±16.2/−3.0±9.6 mm Hg for the rest ( P <.001). These early responders were more likely to be women (adjusted odds ratio, 1.41; 95% confidence interval, 1.10–1.80), had lower BP at baseline, were less likely to have been treated previously (or for less time), and had a less stringent BP target. An initial period of monotherapy achieved BP control in a high proportion of hypertensive individuals with key groups (including women and de novo cases) more likely to show an early BP response.