Real-world effectiveness of valsartan on hypertension and total cardiovascular risk: review and implications of a translational research program

Ivo Abraham1,2, Karen MacDonald2, Christine Hermans3, Ann Aerts3, Christopher Lee2,4, Heidi Brié3, Stefaan Vancayzeele31Center for Health Outcomes and Pharmacoeconomic Research, and Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, US...

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Main Author: Abraham I
Format: Article
Language:English
Published: Dove Medical Press 2011-03-01
Series:Vascular Health and Risk Management
Subjects:
Online Access:https://www.dovepress.com/real-world-effectiveness-of-valsartan-on-hypertension-and-total-cardio-peer-reviewed-article-VHRM
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spelling doaj-184faccf067e4192a44aaf75e944963c2020-11-24T23:33:07ZengDove Medical PressVascular Health and Risk Management1178-20482011-03-01Volume 72092356919Real-world effectiveness of valsartan on hypertension and total cardiovascular risk: review and implications of a translational research programAbraham IIvo Abraham1,2, Karen MacDonald2, Christine Hermans3, Ann Aerts3, Christopher Lee2,4, Heidi Brié3, Stefaan Vancayzeele31Center for Health Outcomes and Pharmacoeconomic Research, and Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA; 2Matrix45, Earlysville, VA, USA; 3Novartis Pharma, Vilvoorde, Belgium; 4School of Nursing, Oregon Health and Science University, Portland, OR, USAAbstract: The pharmacological efficacy of various monotherapy, single pill, and combination therapies of the angiotensin II receptor blocker valsartan have been established, mainly through randomized controlled trials that used similar methodological and statistical platforms and thus enabled synthesis of evidence. The real world effectiveness of valsartan has been studied extensively, but the relative lack of scientific and technical congruence of these studies render synthesis virtually impossible. To date, all have focused on blood pressure outcomes, despite evidence-based calls to grade antihypertensive treatment to patients' total cardiovascular risk. We review a T3 translational research program of seven studies involving valsartan monotherapy as well as single and separate pill combinations, and the determinants and effect on blood pressure and total cardiovascular risk outcomes. All seven studies examined not only the impact of valsartan-based regimens on blood pressure values and control, but also, within a statistical hierarchical approach, the physician- and patient-related determinants of these blood pressure outcomes. Two studies also investigated the determinants and outcomes of valsartan-based treatment on total cardiovascular risk – among the first studies to use this risk coefficient as an outcome rather than only a determinant. These seven studies included a total of 19,533 patients, contributed by 3434 physician-investigators in Belgium – a country particularly well-suited for observational effectiveness studies because of demographics and epidemiology. Each study used the same methodological and statistical platform. We summarize the impact of various valsartan regimens on such outcomes as blood pressure values and control, change in total cardiovascular risk, and reduction in risk by at least one category. We also review the results of statistical multilevel and logistic modeling of physician- and patient-related determinants on these outcomes, including the proportion of variance attributable to a physician class effect before patients enter the equation. In its different formulations, valsartan has major real-world benefits in lowering blood pressure and total cardiovascular risk within a 90-day period. It is essential to understand the physician- and patient-related determinants of blood pressure and total cardiovascular risk outcomes associated with valsartan treatment. Antihypertensive research should expand its historical focus on lowering blood pressure with an emphasis on lowering total cardiovascular research.Keywords: valsartan, angiotensin II receptor blocker, hypertension, total cardiovascular risk, effectiveness, pharmaco-epidemiologyhttps://www.dovepress.com/real-world-effectiveness-of-valsartan-on-hypertension-and-total-cardio-peer-reviewed-article-VHRMvalsartanangiotensin II receptor blockerhypertensiontotal cardiovascular riskeffectivenesspharmaco-epidemiology
collection DOAJ
language English
format Article
sources DOAJ
author Abraham I
spellingShingle Abraham I
Real-world effectiveness of valsartan on hypertension and total cardiovascular risk: review and implications of a translational research program
Vascular Health and Risk Management
valsartan
angiotensin II receptor blocker
hypertension
total cardiovascular risk
effectiveness
pharmaco-epidemiology
author_facet Abraham I
author_sort Abraham I
title Real-world effectiveness of valsartan on hypertension and total cardiovascular risk: review and implications of a translational research program
title_short Real-world effectiveness of valsartan on hypertension and total cardiovascular risk: review and implications of a translational research program
title_full Real-world effectiveness of valsartan on hypertension and total cardiovascular risk: review and implications of a translational research program
title_fullStr Real-world effectiveness of valsartan on hypertension and total cardiovascular risk: review and implications of a translational research program
title_full_unstemmed Real-world effectiveness of valsartan on hypertension and total cardiovascular risk: review and implications of a translational research program
title_sort real-world effectiveness of valsartan on hypertension and total cardiovascular risk: review and implications of a translational research program
publisher Dove Medical Press
series Vascular Health and Risk Management
issn 1178-2048
publishDate 2011-03-01
description Ivo Abraham1,2, Karen MacDonald2, Christine Hermans3, Ann Aerts3, Christopher Lee2,4, Heidi Brié3, Stefaan Vancayzeele31Center for Health Outcomes and Pharmacoeconomic Research, and Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA; 2Matrix45, Earlysville, VA, USA; 3Novartis Pharma, Vilvoorde, Belgium; 4School of Nursing, Oregon Health and Science University, Portland, OR, USAAbstract: The pharmacological efficacy of various monotherapy, single pill, and combination therapies of the angiotensin II receptor blocker valsartan have been established, mainly through randomized controlled trials that used similar methodological and statistical platforms and thus enabled synthesis of evidence. The real world effectiveness of valsartan has been studied extensively, but the relative lack of scientific and technical congruence of these studies render synthesis virtually impossible. To date, all have focused on blood pressure outcomes, despite evidence-based calls to grade antihypertensive treatment to patients' total cardiovascular risk. We review a T3 translational research program of seven studies involving valsartan monotherapy as well as single and separate pill combinations, and the determinants and effect on blood pressure and total cardiovascular risk outcomes. All seven studies examined not only the impact of valsartan-based regimens on blood pressure values and control, but also, within a statistical hierarchical approach, the physician- and patient-related determinants of these blood pressure outcomes. Two studies also investigated the determinants and outcomes of valsartan-based treatment on total cardiovascular risk – among the first studies to use this risk coefficient as an outcome rather than only a determinant. These seven studies included a total of 19,533 patients, contributed by 3434 physician-investigators in Belgium – a country particularly well-suited for observational effectiveness studies because of demographics and epidemiology. Each study used the same methodological and statistical platform. We summarize the impact of various valsartan regimens on such outcomes as blood pressure values and control, change in total cardiovascular risk, and reduction in risk by at least one category. We also review the results of statistical multilevel and logistic modeling of physician- and patient-related determinants on these outcomes, including the proportion of variance attributable to a physician class effect before patients enter the equation. In its different formulations, valsartan has major real-world benefits in lowering blood pressure and total cardiovascular risk within a 90-day period. It is essential to understand the physician- and patient-related determinants of blood pressure and total cardiovascular risk outcomes associated with valsartan treatment. Antihypertensive research should expand its historical focus on lowering blood pressure with an emphasis on lowering total cardiovascular research.Keywords: valsartan, angiotensin II receptor blocker, hypertension, total cardiovascular risk, effectiveness, pharmaco-epidemiology
topic valsartan
angiotensin II receptor blocker
hypertension
total cardiovascular risk
effectiveness
pharmaco-epidemiology
url https://www.dovepress.com/real-world-effectiveness-of-valsartan-on-hypertension-and-total-cardio-peer-reviewed-article-VHRM
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