Outcomes in subgroups of hypertensive patients treated with regimens based on valsartan and amlodipine: An analysis of findings from the VALUE trial

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dc.contributor.authorZanchetti, A.en
dc.contributor.authorJulius, S.en
dc.contributor.authorKjeldsen, S.en
dc.contributor.authorMcInnes, G. T.en
dc.contributor.authorHua, T.en
dc.contributor.authorWeber, M.en
dc.contributor.authorLaragh, J. H.en
dc.contributor.authorPlat, F.en
dc.contributor.authorBattegay, E.en
dc.contributor.authorCalvo-Vargas, C.en
dc.contributor.authorCieslinski, A.en
dc.contributor.authorDegaute, J. P.en
dc.contributor.authorHolwerda, N. J.en
dc.contributor.authorKobalava, J.en
dc.contributor.authorPedersen, O. L.en
dc.contributor.authorRudyatmoko, F. P.en
dc.contributor.authorSiamopoulos, K. C.en
dc.contributor.authorStorset, O.en
dc.date.accessioned2015-11-24T19:00:30Z
dc.date.available2015-11-24T19:00:30Z
dc.identifier.issn0263-6352-
dc.identifier.urihttps://olympias.lib.uoi.gr/jspui/handle/123456789/19545
dc.rightsDefault Licence-
dc.subjectAgeden
dc.subjectAmlodipine/*therapeutic useen
dc.subjectAngiotensin II Type 1 Receptor Blockers/*therapeutic useen
dc.subjectCalcium Channel Blockers/*therapeutic useen
dc.subjectFemaleen
dc.subjectHeart Arrest/mortality/*prevention & controlen
dc.subjectHeart Failure/mortality/*prevention & controlen
dc.subjectHumansen
dc.subjectHypertension/complications/*drug therapyen
dc.subjectMaleen
dc.subjectMiddle Ageden
dc.subjectProportional Hazards Modelsen
dc.subjectSex Factorsen
dc.subjectTetrazoles/*therapeutic useen
dc.subjectTreatment Outcomeen
dc.subjectValine/*analogs & derivatives/therapeutic useen
dc.titleOutcomes in subgroups of hypertensive patients treated with regimens based on valsartan and amlodipine: An analysis of findings from the VALUE trialen
heal.abstractBACKGROUND: In the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial the primary outcome (cardiac morbidity and mortality) did not differ between valsartan and amlodipine-based treatment groups, although systolic blood pressure (SBP) and diastolic blood pressure reductions were significantly more pronounced with amlodipine. Stroke incidence was non-significantly, and myocardial infarction was significantly lower in the amlodipine-based regimen, whereas cardiac failure was non-significantly lower on valsartan. OBJECTIVES: The study protocol specified additional analyses of the primary endpoint according to: sex; age; race; geographical region; smoking status; type 2 diabetes; total cholesterol; left ventricular hypertrophy; proteinuria; serum creatinine; a history of coronary heart disease; a history of stroke or transient ischemic attack; and a history of peripheral artery disease. Additional subgroups were isolated systolic hypertension and classes of antihypertensive agents used immediately before randomization. METHODS: The 15,245 hypertensive patients participating in VALUE were divided into subgroups according to baseline characteristics. Treatment by subgroup interaction analyses were carried out by a Cox proportional hazard model. Within each subgroup, treatment effects were assessed by hazard ratios and 95% confidence intervals. RESULTS: For cardiac mortality and morbidity, the only significant subgroup by treatment interaction was of sex (P = 0.016), with the hazard ratio indicating a relative excess of cardiac events with valsartan treatment in women but not in men, but SBP differences in favour of amlodipine were distinctly greater in women. No other subgroup showed a significant difference in the composite cardiac outcome between valsartan and amlodipine-based treatments. For secondary endpoints, a sex-related significant interaction was found for heart failure (P < 0.0001), with men but not women having a lower incidence of heart failure with valsartan. CONCLUSION: As in the whole VALUE cohort, in no subgroup of patients were there differences in the incidence of the composite cardiac endpoint with valsartan and amlodipine-based treatments, despite a greater blood pressure decrease in the amlodipine group. The only exception was sex, in which the amlodipine-based regimen was more effective than valsartan in women, but not in men, whereas the valsartan regimen was more effective in preventing cardiac failure in men than in women.en
heal.accesscampus-
heal.fullTextAvailabilityTRUE-
heal.identifier.primary10.1097/01.hjh.0000249692.96488.46-
heal.identifier.secondaryhttp://www.ncbi.nlm.nih.gov/pubmed/17053536-
heal.journalNameJournal of Hypertensionen
heal.journalTypepeer-reviewed-
heal.languageen-
heal.publicationDate2006-
heal.recordProviderΠανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικήςel
heal.typejournalArticle-
heal.type.elΆρθρο Περιοδικούel
heal.type.enJournal articleen

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