Hierarchical modeling of blood pressure determinants and outcomes following valsartan treatment in hypertensive patients with known comorbidities: pooled analysis of six prospective real-world studies including 11,999 patients

Six prospective real-world studies of antihypertensive treatment with valsartan-centric regimens were pooled to (1) examine the effectiveness of ∼90 days of second- or later-line valsartan treatment in hypertensive patients with known comorbidities; and (2) identify physician and patient-related determinants associated with systolic (SBP) and diastolic blood pressure (DBP) outcomes in these patients.; Pooled analysis of an evaluable sample of 11,999 hypertensive patients with known comorbidities treated ∼90 days with valsartan-centric regimens. We applied hierarchical linear and logistic regression models to identify determinants of blood pressure (BP) outcomes and a potential physician class effect.; Valsartan regimens resulted in mean(SD) systolic (SBP) and diastolic (DBP) reductions of 18.0(15.8)mmHg and 9.5(10.1)mmHg, respectively, at ∼90 days; yielding SBP, DBP and combined SBP/DBP control rates of 44.0%, 67.2% and 39.3%, respectively. About a quarter of the variance in 90-day BP values was attributable to a physician class effect. BP outcomes declined with physicians' increasing years in practice and being male. At the patient-level, BP outcomes declined with SBP and DBP at diagnosis; diabetes; higher cholesterol and BMI; lower valsartan and HCTZ doses; and concomitant anti-hypertensives. Older age was associated with improved DBP. A proxy of physician vigilance, cardiovascular disease history was associated with improved BP outcomes; as were patient adherence and higher doses of valsartan in combination with HCTZ.; Valsartan-centric regimens have significant BP lowering benefits in this pooled sample of patients with known comorbidities. Many observed determinants of BP outcomes are modifiable or manageable.