Treating systolic hypertension in the very elderly with valsartan-hydrochlorothiazide vs. either monotherapy: ValVET primary results

Abstract

This 16-week trial investigated the efficacy and safety of single-pill valsartan/hydrochlorothiazide (HCTZ) vs. the individual components in patients 70 years and older with systolic hypertension. Patients were randomized to valsartan/HCTZ 160/12.5 mg (n=128), HCTZ 12.5 mg (n=128), or valsartan 160 mg (n=128) for 4 weeks. Patients whose blood pressure (BP) was ≥140/90 mm Hg at weeks 4, 8, or 12 were up-titrated to a maximum of valsartan/HCTZ 320/25 mg. Week 4 systolic BP reduction (primary efficacy outcome) was greater with valsartan/HCTZ than valsartan (-17.3 mm Hg vs. -8.6 mm Hg, P <.0001) but only marginally greater than HCTZ (-13.6 mm Hg, P =.096). Median time to BP control was shorter with valsartan/HCTZ (4 weeks) vs HCTZ (8 weeks, P<.05) or valsartan (12 weeks, P<.0001). Thiazide monotherapy was more effective than angiotensin receptor blocker monotherapy (by about 5 mm Hg), but greater antihypertensive efficacy was achieved by initiating treatment with combination valsartan/HCTZ in the elderly.

Trial registration: ClinicalTrials.gov NCT00698646.

© 2011 Wiley Periodicals, Inc.

Figures

Figure 1

Study design. BP indicates blood pressure; HCTZ, hydrochlorothiazide; V, valsartan.

Figure 2

Patient disposition. HCTZ indicates hydrochlorothiazide; V, valsartan.

Figure 3

Mean sitting systolic blood pressure (MSSBP) (A) and mean sitting diastolic blood pressure (MSDBP) (B). BP indicates blood pressure; HCTZ, hydrochlorothiazide; LSM, least‐squared mean; V, valsartan. Error bars represent 95% confidence interval (CI).

Figure 4

Proportion of patients achieving mean sitting systolic blood pressure/mean sitting diastolic blood pressure (MSSBP/MSDBP)