Long-Term VA Study Raises the Bar for BP Control
In an 8-year study comprised of 15 veteran affairs (VA) medical centers across the country, the use of automated reminders for providers to control patient blood pressure (BP) resulted in an impressive rate of patients reaching adequate BP control.
At the beginning of the study, only 40% to 50% of the approximately 500,000 VA patients had their BP controlled. After 8 years, >70% of the patients had reached BP control, an "astonishingly good" rate, said Henry Black, MD, of New York University Center for the Prevention of Cardiovascular Disease, NY, and past president of ASH.
These results indicate that BP control can be reached by all hypertensive patients, who are often seen as difficult to treat. Providers and payers may need to consider using such tools to increase the rate of BP control, as a way to reduce as the costs associated with elevated BP and its attendant risks for increased morbidity and mortality.
New ARB Outperforms Older Agents
Two phase 3 trials presented at ASH suggest that the new angiotensin receptor blocker (ARB) azilsartan, currently under review by the US Food and Drug Administration (FDA), was more effective at its highest dose (80 mg/day) in lowering BP than 2 other ARBs already on the market—olmesartan (Benica) and valsartan (Diovan). The lower doses of azilsartan, 20-mg/day and 40-mg/day, did not outperform olmesartan and valsartan in lowering BP.
In addition, results of a late-breaking, 10-week head-to-head trial presented at the meeting showed that a fixed-dose combination of azilsartan and the (thiazidelike) diuretic chlorthalidone led to better BP control than the combination of azilsartan plus the diuretic hydrochlorothiazide (HCTZ).
All patients (N = 600) had moderate-to-severe hypertension and received 40-mg/day of azilsartan alone for 2 weeks. They were then randomized in weeks 3 to 6 to the fixed-dose combination of azilsartan 40-mg/day plus chlorthalidone 12.5-mg/day (n = 302) or azilsartan 40 mg/day with HCTZ 12.5-mg/day (n = 303). In weeks 7 to 10, both diuretics were titrated to 25 mg/day for those who did not reach BP target with the 12.5-mg dose. The fixed-dose combination significantly lowered BP compared with azilsartan plus HCTZ.
George Bakris, MD, of the University of Chicago Pritzker School of Medicine, IL, presented the study, predicting that this drug is going to become very popular if, as expected, it receives FDA approval in the near future. This is the first trial to compare the effects of these 2 diuretics in combination with an ARB.
Phase 4 Study Targets Hispanics with Hypertension
Hispanics currently comprise 14% of the US population and are the fastest growing ethnic minority group in the country. According to a study presented at ASH, 20% of adult Hispanics have hypertension, and Hispanics also have higher rates of diabetes and obesity compared with American whites, which are known risk factors for hypertension, heart attacks, stroke, and kidney failure.
In this 8-week, randomized, double-blind, placebo controlled dose-titration trial conducted in several centers in the country, 113 Hispanic women and 164 Hispanic men (aged ≥18 years) with stage I-II hypertension received either nebivolol (Bystolic) 5-mg/day (n = 141) or placebo (n =136); the dose was titrated at a 2-week interval as needed, to a maximum of 40-mg/day.
At the end of the 8 weeks, mean change from baseline in systolic and diastolic BP was –14.1/–11.1 mm Hg for those taking nebivolol compared with –9.3/–7.3 mm Hg for the placebo group, respectively, representing a significant difference.
Discontinuation rate because of adverse events was 0% for the active drug compared with 4.4% for the placebo. The adverse events profile was similar among the 2 groups.