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Abstract

The Valsartan Antihypertensive Long-Term Use Evaluation (VALUE) Trial compared coronary heart disease outcome in two anti-hypertensive treatment strategies based on either an angiotensin receptor blocker, valsartan, or a calcium channel blocker (CCB), amlodipine. In both patient groups a diuretic was added, if necessary, in an attempt to achieve blood pressure (BP) goals. Follow-up of over 15,000 patients was maintained for 4.2 years. There were no differences in the primary composite endpoint of cardiac morbidity and mortality (which included interventional procedures, hospitalised heart failure, non-fatal myocardial infarction and fatal coronary heart disease, however myocardial infarction and stroke events occurred less commonly on amlodipine than on valsartan — the former achieving statistical significance [p=0.02 and p=0.08 respectively]). There was a non-significant excess of hospitalised heart failure on amlodipine (p=0.012). However, lower BPs early in the trial probably accounted for most of the observed benefits in favour of the CCB. The angiotensin receptor blocker arm was associated with less new onset diabetes.

The results of VALUE add further support to the evidence that blood pressure control is the major determinant in outcome in trials of antihypertensive therapy.

Keywords

VALUE trial blood pressure angiotensin receptor blockers calcium channel blockers

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References

Julius S. , Kjeldsen SE , Weber M. et al. VALUE trial group. Outcomes in hypertensive patients at high cardiovascular risk

treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004;363:2022-31.

Sever P. ACE inhibitors in hypertension: still a shortage of evidence. JRAAS 2000;2:117-18.

Sever PS Recent clinical trials: a critical appraisal. Curr Hypertens Rep 1999;4:333-6.

Blood Pressure Lowering Treatment Trialists Collaboration. Effects of different blood-pressure lowering regimens on major cardiovascular events: results of prospectivelydesigned overviews of randomised trials. Lancet 2003;362: 1527-35.

comes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000;355:253-9.

The EURopean trial On reduction of cardiac events with Perindopril in stable coronary disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003;362:782-8.

Dahlof B. , Devereaux R. , Kjeldsen S. et al. for the LIFE study Group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol . Lancet 2002;359: 995-1003.

10.

Lithell H. , Hansson L. , Skoog I. et al. for the SCOPE Study Group. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomised double-blind intervention trial. J Hypertens 2003;21:875-86.

11.

The ALLHAT Officers and Co-ordinators for the ALLHAT Collaborative Research Group. Major cardiovascular events in hypertensive patients randomised to Doxazosin vs. chlorthalidone. The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT). J Am Med Ass 2000;283:1967-75.

12.

ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomised to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 23:2981-97.

13.

Brown MJ , Palmer CR , Castaigne A. et al. Morbidity and mortality in patients randomised to double-blind treatment with a long-acting-calcium channel blocker of diuretic in the International Nifedipine GITS study: Intervention as a Goal in Hypertension Treatment (INSIGHT) . Lancet 2000;356:366-72.

14.

Hansson L. , Lindholm LH , Niskanen L. et al. Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet 1999;353:611-16.

15.

Higashiura K. , Ura N. , Miyazaki Y. , Shimamoto K. Effect of an angiotensin II receptor antagonist, candesartan, on insulin resistance and pressor mechanisms in essential hypertension . J Hum Hypertens 1999;3(suppl 1):S71-S74.

16.

Lithell HO Insulin resistance and diabetes in the context of treatment of hypertension . Blood Press 1998;(suppl 3):28-31.

17.

Engelhorn T. , Goerike S. , Doerfler A. et al. The angiotensin II type 1-receptor blocker candesartan increases cerebral blood flow, reduces infarct size, and improves neurologic outcome after transient cerebral ischemia in rats. J Cereb Blood Flow Metab 2004;4:467-74.

18.

Medical Research Council Working Party. MRC trial of treatment of mild hypertension: principal results. BMJ 1985; 291:97-104.

19.

MRC Working Party. Medical Research Council trial of treatment of hypertension in older adults: principal results. BMJ 1992;304:405-12.

20.

Williams B. , Poulter N. , Brown M. et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society 2004-BHS IV. J Hum Hypertens 2004;18:139-85.

21.

Wolf-Maier K. , Cooper RS , Kramer H. et al. Hypertension treatment and control in five European countries, Canada, and the United Kingdom . Hypertension 2004;43:10-17.

22.

Sever PS , Dahlof B. , Poulter NR et al. Rationale, design, methods and baseline demography of participants of the Anglo-Scandinavian Cardiac Outcomes Trial. ASCOT investigators. J Hypertens 2001;6:1139-47.

The VALUE trial: a commentary

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