The Valsartan Antihypertensive Long-Term Use Evaluation (VALUE) Trial

Abstract

Abstract-In the main Valsartan Antihypertensive Long-Term Use Evaluation (VALUE) report, we investigated outcomes in 15 245 high-risk hypertensive subjects treated with valsartan-or amlodipine-based regimens. In this report, we analyzed outcomes in 7080 patients (46.4%) who, at the end of the initial drug adjustment period (6 months), remained on monotherapy. Baseline characteristics were similar in the valsartan (Nϭ3263) and amlodipine (Nϭ3817) groups. Time on monotherapy was 3.2 years (78% of treatment exposure time). The average in-trial blood pressure was similar in both groups. Event rates in the monotherapy group were 16% to 39% lower than in the main VALUE trial. In the first analysis, we censored patients when they discontinued monotherapy ("censored"); in the second, we counted events regardless of subsequent therapy (intention-to-treat principle). We also assessed the impact of duration of monotherapy on outcomes. No difference was found in primary composite cardiac end points, strokes, myocardial infarctions, and all-cause deaths with both analyses. Heart failure in the valsartan group was lower both in the censored and intention-to-treat analyses (hazard ratios: 0.63, Pϭ0.004 and 0.78, Pϭ0.045, respectively). Longer duration of monotherapy amplified between-group differences in heart failure. New-onset diabetes was lower in the valsartan group with both analyses (odds ratios: 0.78, Pϭ0.012 and 0.82, Pϭ0.034). Thus, despite lower absolute event rates in monotherapy patients, the relative risks of heart failure and new-onset diabetes favored valsartan. Moreover, these findings support the feasibility of comparative prospective trials in lower-risk hypertensive patients.

Effects of 12 weeks of treatment with fermented milk on blood pressure, glucose metabolism and markers of cardiovascular risk in patients with type 2 diabetes: a randomised double-blind placebo-controlled study

“…2). Increased activity of the renin angiotensin system has been associated with obesity and glucose intolerance, and prospective epidemiological studies have reported that blocking the system using either ACE inhibitors or ARBs has been shown to reduce the incidence of diabetes (27,28,29,30) and both ACE-inhibitors and ARBs may improve insulin action to different extents (31,32) as well as insulin secretion (33). Accordingly, it may be considered biologically plausible that bioactive peptides in the Cardi04 yogurt inhibiting ACE may reduce plasma glucose levels in patients with diabetes.…”

Clinical Inertia in Poorly Controlled Elderly Hypertensive Patients: A Cross-Sectional Study in Spanish Physicians to Ascertain Reasons for Not Intensifying Treatment

“…If we adjust the prevalence according to age, we see that 75 % of hypertensive women and 65 % of hypertensive men are aged [60 years [19] and that three of every four patients with known cardiovascular disease have hypertension [20]. Studies [21,22] indicate that clinical inertia can have an adverse impact on clinical outcomes because hypertensive patients need early BP control and any delay is associated with an increased incidence of cardiovascular events. Long-term follow-up studies are needed to measure the impact of clinical inertia on clinical outcomes in hypertensive patients.…”

Novel Mechanism and Role of Angiotensin II–Induced Vascular Endothelial Injury in Hypertensive Diastolic Heart Failure

“…In the present work, to determine the potential role of AII in vascular endothelial injury, we compared the effect of valsartan and amlodipine on vascular injury of DS rats (Figures 1 and 2 and supplemental Figures I and II). Recent report by Julius et al 23 on subanalysis of the Valsartan Antihypertensive Long-Term Use Evaluation (VALUE) trial has indicated that valsartan is superior to amlodipine in terms of the prevention of hypertensive heart failure, although its mechanism remains to be clarified. Therefore, our present study, comparing between valsartan and amlodipine in DS rats, is of clinical relevance.…”