Effects of valsartan on morbidity and mortality in uncontrolled hypertensive patients with high cardiovascular risks: KYOTO HEART Study
Sawada T, Yamada H, Dahlöf B, Matsubara H, KYOTO HEART Study Group. Eur Heart J. 2009 Oct;30(20):2461-9
This trial using a PROBE design compared add-on therapy with an ARB as compared to alternative antihypertensive agents in Japanese patients with uncontrolled hypertension. A reduction in hard clinical endpoints was observed in the Valsartan add-on group.
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Abstract:
AIMS: The objective was to assess the add-on effect of valsartan on top of the conventional treatment for high-risk hypertension in terms of the morbidity and mortality. METHODS AND RESULTS: The KYOTO HEART Study was of a multicentre, Prospective Randomised Open Blinded Endpoint (PROBE) design, and the primary endpoint was a composite of fatal and non-fatal cardiovascular events (clintrials.gov NCT00149227). A total of 3031 Japanese patients (43% female, mean 66 years) with uncontrolled hypertension were randomized to either valsartan add-on or non-ARB treatment. Median follow-up period was 3.27 years. In both groups, blood pressure at baseline was 157/88 and 133/76 mmHg at the end of study. Compared with non-ARB arm, valsartan add-on arm had fewer primary endpoints (83 vs. 155; HR 0.55, 95% CI 0.42-0.72, P = 0.00001). CONCLUSION: Valsartan add-on treatment to improve blood pressure control prevented more cardiovascular events than conventional non-ARB treatment in high-risk hypertensive patients in Japan. These benefits cannot be entirely explained by a difference in blood pressure control.
October 24th, 2009 at 6:46 pm
An interesting paper which supports the use of ARBs to reduce hard clinical endpoints. My only concern is whether the results of this paper can be generalized beyond Japanese patients.
October 28th, 2009 at 8:17 am
My first concern is according to that of R Jenkins. The second one is the lack of explicantions about the different incidence of brain vascular events of Japanese people versus the others populations, difference on which could possibly be based the best efficacy of ARBS