Baseline Characteristics and Early Blood Pressure Control in the CONVINCE Trial

Area of Science:

• Cardiovascular Medicine
• Clinical Pharmacology
• Hypertension Research

Background:

• Suboptimal blood pressure (BP) control rates globally highlight a significant public health challenge.
• National surveys indicate low BP control rates in hypertensive populations, emphasizing the need for effective treatment strategies.

Purpose of the Study:

• To assess BP control during the initial two years of the Controlled ONset Verapamil INvestigation of Cardiovascular Endpoints (CONVINCE) study.
• To describe baseline characteristics of patients enrolled in this international clinical trial comparing antihypertensive treatments.

Main Methods:

• An international clinical trial involving 16,602 hypertensive patients randomized to controlled-onset extended-release verapamil or investigator's choice (atenolol/hydrochlorothiazide).
• A transtelephonic computer system guided medication titration, recommending dose or agent increases when BP exceeded 140/90 mm Hg.
• BP control was assessed at randomization and throughout the 2-year treatment period.

Main Results:

• At randomization, only 20.3% of participants had a BP <140/90 mm Hg, with average BPs of 148/85 mm Hg (treated) and 161/94 mm Hg (untreated).
• Following forced titration, 84.8% of subjects achieved the goal BP (<140/90 mm Hg).
• BP control was maintained in 67-69% of subjects over two years, with systolic BP control being more challenging than diastolic BP control.

Conclusions:

• A forced titration strategy significantly improves BP control rates in hypertensive patients.
• The US national goal of 50% hypertension control may be achievable with such systematic titration approaches.
• Factors like dedicated investigators, free care/medications, and well-educated subjects may facilitate goal attainment in clinical trials.