Optimising management of hypertension in primary care: The Valsartan Intensified Primary Care Reduction of Blood Pressure (Viper-Bp) Study

Stewart, Simon; Carrington, Melinda; Swemmer, C.; Kurstjens, N.; Jennings, Garry

doi:10.1016/j.ijcard.2010.12.055

Cited by 11 publications

(11 citation statements)

References 24 publications

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“…Although there is a broad range of pharmacological agents with proven efficacy to reduce BP in clinical trials [15][16][17][18], it is clear that translation into the 'real world' is more challenging. This reinforces our contention that more trials to evaluate real world effectiveness management strategies are required to better apply proven BP-lowering treatments [19]. Moreover, there should be greater application and utilization of funding mechanisms and incentives to support not only pharmacotherapy, but proven and integrated management strategies with the capacity to significantly reduce death and disability from CVD via more effective risk reduction.…”

Section: Discussionsupporting

confidence: 53%

Pressure points in primary care

Carrington

Jennings

Stewart³

2013

Journal of Hypertension

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Section: Discussionsupporting

confidence: 53%

Pressure points in primary care

Carrington

Jennings

Stewart³

2013

Journal of Hypertension

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“…As described in greater detail previously [13], individuals routinely managed by family physicians partaking in the VIPER-BP study were eligible to participate if they were aged at least 18 years; diagnosed with hypertension requiring active pharmacological treatment according to guidelines and; consented to participate. Exclusion criteria were as follows: mean initial sitting SBP at least 180 mmHg; prescription of at least three antihypertensive agents; severe renal disease (clinical diagnosis and/or estimated glomerular filtration rate <60 ml/min per 1.73 m 2 ); and/or contraindications to an angiotensin receptor blocker, calcium channel blocker, or a thiazide diuretic.…”

Section: Methodsmentioning

confidence: 99%

“…The VIPER-BP study was a multicenter randomized controlled trial that recruited 2337 hypertensive individuals via 119 primary care clinics and over 250 family physicians Australia-wide [13]. Participating clinics comprised a representative combination of small, independent (one to two physicians), and larger clinics with shared protocols and governance structures (an increasing feature of primary care in Australia).…”

Section: Methodsmentioning

confidence: 99%

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

Stewart

Stocks

Burrell

et al. 2014

Journal of Hypertension

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Objective:To examine protocol adherence to structured intensive management in the Valsartan Intensified Primary carE Reduction of Blood Pressure (VIPER-BP) study involving 119 primary care clinics and 1562 randomized participants.Methods:Prospective criteria for assessing adherence to treatment prescription, uptitration, and visit attendance at 6, 10, 14, and 18 weeks postrandomization were applied to 1038 intervention participants. Protocol adherence scores of 1–5 (least to most adherent) were compared to blood pressure (BP) control during 26 weeks of follow-up.Results:Mean age was 59.3 ± 12.0 years, 963 (62%) were men, and 1045 (67%) had longstanding hypertension. Clinic attendance dropped from 91 (week 6) to 83% (week 26) and pharmacological instructions were followed for 93% (baseline) to 61% at week 14 (uptitration failures commonly representing protocol deviations). Overall, 26-week BP levels and BP target attainment ranged from 132 ± 14/79 ± 9 and 51% to 141 ± 15/83 ± 11 mmHg and 19% in those participants subject to the highest (n = 270, 26%) versus least (n = 148, 14%) per protocol adherence, respectively; adjusted relative risk (RR) 1.22 per unit protocol adherence score, 95% confidence interval (CI) 1.15–1.31; for achieving BP target (P < 0.001). Participants with a per protocol score of 4 or 5 (512/1038, 49.3%) were 1.54-fold (95% CI 1.31–1.81; P < 0.001) more likely to achieve their individual BP target compared with usual care. Clinics equipped with a practice nurse significantly influenced protocol adherence (adjusted RR 1.20, 95% CI 1.06–1.37; P = 0.004) and individual BP control (RR 1.21, 95% CI 1.04–1.41; P = 0.015).Conclusion:There is considerable potential for structured care management to improve BP control in primary care, especially when optimally applied.

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“…Beyond the application of pharmacotherapy, there is strong evidence, including a Cochrane review of the literature, that more intensive and structured management in the primary care setting will significantly improve BP control rates . We therefore conducted the multicenter, randomized Valsartan Intensified Primary Care Reduction of Blood Pressure (VIPER‐BP) study to test the clinical effectiveness and overall safety of a more intensive and structured approach to optimizing BP control in a group of individuals with persistently high BP levels in primary care. During the randomized component of comparing the VIPER‐BP intervention (n=1038) with an enhanced form of usual care (n=524), the primary endpoint (individual risk‐based BP target) was achieved in 36.2% vs 27.4% of participants, respectively (adjusted relative risk 1.28 in favor of the intervention; P =.001) and the classical BP target of ≤140/90 mm Hg in 63.5% vs 54.0% of participants (adjusted relative risk 1.18 in favor of the intervention; P <.001) .…”

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confidence: 99%

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

Stewart

Carrington²,

Swemmer

et al. 2013

J of Clinical Hypertension

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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).

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Optimising management of hypertension in primary care: The Valsartan Intensified Primary Care Reduction of Blood Pressure (Viper-Bp) Study

Cited by 11 publications

References 24 publications

Pressure points in primary care

Pressure points in primary care

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

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

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