Determinants of Achieving Early Blood Pressure Control with Monotherapy in a Primary Care Setting

Abstract

7This 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 Valsartan 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 59AE12 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 À22.6AE12.1/À12.9AE8.2 mm Hg vs À4.2AE16.2/ À3.0AE9.6 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. J Clin Hypertens (Greenwich).

More rigorous protocol adherence to intensive structured management improves blood pressure control in primary care

“…First, men were approximately one-third more likely than women to achieve the primary endpoint. Although this finding appears to contrast with earlier study findings [23], it probably reflects the randomization of female participants with more persistent forms of hypertension and well described, sex-based differences in treatment response [24]. Reinforcing the links between a high population prevalence of both obesity and hypertension [25], increasing BMI was also negatively correlated with BP response to treatment.…”

Impact of nurse-mediated management on achieving blood pressure goal levels in primary care: Insights from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study

“…In the Kaiser Permanente programme, medical assistants rather than PNs were used to perform follow-up visits and inform primary care physicians of BP values. Consistent with a previous report from the VIPER-BP Study suggesting that primary care physicians with less demanding workloads are more proficient in achieving BP targets, 13 these data suggest that it is the ability of a dedicated health care professional, rather than a particular health discipline, that can best facilitate optimal BP management. Ultimately, the decision to employ additional health personnel to deliver programmes such as the VIPER-BP intervention will likely vary from one health system to another, and perhaps within any one particular health care system depending on associated costs and workforce demands.…”

“…The rationale, design and pre-specified analyses of the VIPER-BP Study have been published previously. 10 In summary, these analyses explored: 1) early BP control not requiring more intensive management in a sub-set of participants; 13 2) the overall beneficial effect of the VIPER intervention on an intention-to-treat basis 11 and; 3) the impact of per-protocol adherence on achieving BP goal levels. 12 Briefly, eligible study participants were recruited from over 100 primary care clinics involving more than 250 physicians Australia-wide, if they were aged ⩾ 18 years and diagnosed with hypertension requiring active pharmacological treatment according to Australian expert hypertension guidelines.…”