While patients with Type 2 diabetes believe glucose control is important, medication side effects and risks influence patients' treatment choices. Medication-related weight gain and cardiovascular risk are significant predictors of likely medication non-adherence.

Abstract-This study evaluated the effects of initial versus delayed treatment with a drug combination on blood pressure (BP) control and the risk of cardiovascular (CV) events in hypertensive patients. Clinical trials suggest that the time to BP control is an important determinant of long-term outcomes, but real-world evidence is scarce. Using electronic medical charts (2005)(2006)(2007)(2008)(2009), we retrospectively analyzed 1762 adult patients with BP elevation initiating combination therapy matched 1:1 with similar patients initiating monotherapy and later switched to combination therapy. Incidence rate ratios of CV events (myocardial infarction, stroke/transient ischemic attack, or hospitalization for heart failure) or all-cause death and Kaplan-Meier analyses of time to BP control were compared between cohorts. Hazard ratios indicating the effects of initial treatment on CV events and BP control were estimated using time-varying Cox proportional hazard models. Initial combination therapy was associated with a significant reduction in the risk of CV events or death (incidence rate ratio, 0. BP reduction and goal attainment, as well as the impact on healthcare resource use in a real-world, practice-based setting. Methods Data SourceElectronic medical chart data between January 2005 and November 2009 from a large integrated delivery network of physicians and hospitals, all sharing a single laboratory, were used to conduct the analysis. The database is de-identified and is in compliance with the Health Insurance Portability and Accountability Act of 1996 to preserve patient anonymity and confidentiality. Data elements used in the present analysis included patient demographics, inpatient and outpatient medical services, prescriptions, laboratory results, and clinical measures such as BP, height and weight, and smoking status. Study DesignAdult patients with uncontrolled BP, newly initiated on antihypertensive therapy including angiotensin-converting enzyme inhibitors, calcium channel blockers, angiotensin II receptor blockers, or diuretics, given as a single agent (monotherapy) or a drug combination, were identified. The study population was stratified into the following mutually exclusive exposure groups: patients initiating combination therapy for ≥60 days (combination therapy cohort) and patients initiating monotherapy for ≥60 days with the subsequent addition of a second agent (add-on cohort). Combination therapy included a single-pill (fixeddose) combination or dual free combination of angiotensin-converting enzyme inhibitor and calcium channel blocker, angiotensin-converting enzyme inhibitor and diuretic, angiotensin II receptor blocker and calcium channel blocker, or angiotensin II receptor blocker and diuretic. A baseline period of 90 days before treatment initiation was imposed to evaluate baseline characteristics and to ascertain that patients had uncontrolled BP, defined as ≥1 BP reading ≥140/90 mm Hg or ≥130/80 mm Hg for patients with diabetes mellitus or CKD. We excluded from the analysis patients...

Objective:To compare the efficacy of valsartan in systolic (SBP) and diastolic blood pressure (DBP) reduction with other angiotensin II receptor blockers (ARBs) in essential hypertension.Methods:Systematic literature search of databases between October 1997 and May 2008. Meta-analysis of short-term, double-blind, parallel group, randomised controlled trials (RCTs) for treatment of adult hypertension (DBP: 90–115 mmHg). Random-effects meta-regression adjusting for baseline blood pressure (BP) was used to analyse the data. Mean change in SBP and DBP was estimated for each individual drug and dose combination.Results:In all, 31 RCTs (n = 13,110 patients) were included in the analysis. Six studies include trial arms with candesartan, six irbesartan, 13 losartan, two olmesartan, five telmisartan and 12 valsartan. The weighted average reduction in mean SBP and DBP for valsartan 160 mg was −15.32 mmHg (95% CI: −17.09, −13.63) and −11.3 mmHg (95% CI: −12.15, −10.52) and for 320 mg was −15.85 mmHg (95% CI: −17.60, −14.12) and −11.97 mmHg (95% CI: −12.81, −11.16); these are statistically significantly greater reductions compared with losartan 100 mg, which was −12.01 mmHg (95% CI: −13.78, −10.25) and −9.37 mmHg (95% CI: −10.18, −8.54) for SBP and DBP respectively. There is evidence that valsartan 160 mg reduces SBP and DBP more than irbesartan 150 mg and reduced DBP more than candesartan 16 mg. No other statistically significant difference in efficacy is demonstrated.Conclusion:Valsartan administered at 160 or 320 mg is more effective at lowering BP than losartan 100 mg and shows comparable efficacy to other ARBs in patients with essential hypertension.

The results of this study show that in daily clinical practice early discontinuation of antihypertensive drug treatment in primary prevention increases the risk of subsequent AMI or stroke.

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