Sorting the Wheat from the Chaff: Initial Blood Pressure Control in the VIPER-BP Study Cohort of Primary Care Patients with Previously Uncontrolled Hypertension

Abstract

patients randomised to usual care (UC) or an algorithm to optimise BP control in the Valsartan Intensified Primary carE Reduction of Blood Pressure (VIPER-BP) Study. Methods: Prospective, multi-centre RCT involving 119 primary care clinics. Based on 26 week follow-up data we used (a) change in risk profile and (b) age, initial systolic and diastolic BP and change in BPs, to calculate changes in absolute five year cardiovascular risk score (ACVRS) and relative risk (RR) of a future coronary artery disease (CAD) or stroke event. Results: 1562patients (59± 12years, 62%men, 67%prior hypertension and BP 150± 17/88± 11mmHg) remaining above their individualised BP target were randomised (1:2 ratio) to UC (n= 524) or the VIPER-BP intervention (n= 1038). Consistent with significantly greater falls in BP in favour of the VIPER-BP intervention, mean falls in ACVRS (from baseline) were greatest in VIPER-BP versus UC patients (−3.7± 4.5% vs. −2.6± 4.5%, adjusted mean difference−1.13, 95%CI−1.63 to−0.64%, p< 0.001). Similarly, the adjusted risk of CAD (RR 0.75± 0.36 vs. 0.81± 0.39; p< 0.001) and stroke (RR 0.69± 0.49 vs. 0.80± 0.52; p< 0.001)was attenuatedmost in theVIPER-BP group. Conclusions: A structured care algorithm to optimise primary care management of hypertension not only results in loweredBP, but reducesACVRSandRRof future CVD.