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Treating high-risk hypertensive patients
1Department of Internal Medicine, University of Michigan, Ann Arbor 48109-0357, USA.
Insights
Treating hypertension requires managing blood pressure and associated cardiovascular risk factors like insulin resistance. Newer medications may offer benefits beyond blood pressure control, as investigated in the VALUE trial.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Hypertension management involves normalizing blood pressure and addressing associated cardiovascular risk factors.
- Insulin resistance, dyslipidemia, and prothrombotic states often coexist with hypertension, increasing cardiovascular morbidity and mortality.
- Current treatment guidelines emphasize diuretics and beta-blockers, but newer agents' long-term benefits require evaluation.
Purpose of the Study:
- To evaluate the long-term efficacy of newer antihypertensive agents.
- To assess the benefits of complete angiotensin II blockade beyond blood pressure control.
- To investigate cardiovascular outcomes in high-risk hypertensive patients.
Main Methods:
- The Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial compares valsartan (angiotensin II receptor blocker) with amlodipine (calcium channel blocker).
- The trial enrolls hypertensive patients at high risk for cardiovascular events.
- Long-term cardiovascular morbidity and mortality are primary endpoints.
Main Results:
- Data on long-term efficacy of newer agents are still being gathered.
- The VALUE trial aims to provide evidence on the benefits of complete angiotensin II blockade.
- Specific results regarding the comparison between valsartan and amlodipine are pending.
Conclusions:
- Comprehensive hypertension management should address multiple cardiovascular risk factors.
- Newer antihypertensive agents, such as angiotensin II receptor blockers, may offer additional benefits.
- Ongoing trials like VALUE are crucial for understanding the long-term impact of these medications on cardiovascular outcomes.
Abstract:
Successful treatment of hypertension entails not only normalizing high blood pressure, but also addressing the associated risk factors that increase the likelihood of cardiovascular morbidity and mortality. Hypertension often occurs in a setting of insulin resistance, hyperinsulinemia, dyslipidemia, and a prothrombotic state. A number of epidemiologic studies have shown that the clustering of these abnormalities is associated with increased risk of cardiovascular morbidity and mortality. Therefore, it is rational to direct therapy at moderating these risk factors as well as at lowering blood pressure in hypertensive patients. This is particularly important in patients with comorbidities such as diabetes, cardiovascular disease, or renal insufficiency. Many physicians prescribe only diuretics and beta-blockers, agents that have demonstrated efficacy in long-term randomized controlled trials. However, this approach does not consider the potential benefits of newer agents for which long-term outcome data are not yet available. The ongoing Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial, in which the angiotensin II subtype 1 receptor blocker valsartan is compared with the third-generation calcium channel blocker amlodipine, should provide important evidence on the long-term efficacy of these newer agents. A unique feature of VALUE is that it is specifically enrolling into the only current trial, now under way, hypertensive men and women at a relatively high risk for a cardiovascular event to determine the benefits of complete blockade of angiotensin II beyond those of the control of blood pressure.