Blood Pressure Outcomes in Patients Receiving Angiotensin II Receptor Blockers in Primary Care: A Comparative Effectiveness Analysis From Electronic Medical Record Data
Article first published online: 18 OCT 2011
© 2011 Wiley Periodicals, Inc.
The Journal of Clinical Hypertension
Volume 13, Issue 11, pages 801–812, November 2011
How to Cite
Ram, C. V. S., Ramaswamy, K., Qian, C., Biskupiak, J., Ryan, A., Quah, R. and Russo, P. A. (2011), Blood Pressure Outcomes in Patients Receiving Angiotensin II Receptor Blockers in Primary Care: A Comparative Effectiveness Analysis From Electronic Medical Record Data. The Journal of Clinical Hypertension, 13: 801–812. doi: 10.1111/j.1751-7176.2011.00539.x
- Issue published online: 3 NOV 2011
- Article first published online: 18 OCT 2011
- Manuscript received: July 5, 2011; Accepted: July 27, 2011
J Clin Hypertens (Greenwich). 2011;13:801–812. ©2011 Wiley Periodicals, Inc.
The authors examined the comparative effectiveness of 4 angiotensin receptor blockers (ARBs) in patients with hypertension using a large electronic medical record database. Analysis of covariance and logistic multivariate regression models were used to estimate the blood pressure (BP) outcomes of 73,012 patients during 13 months of treatment with olmesartan, losartan, valsartan, and irbesartan. Results were adjusted by baseline BP, starting dose, year, age, sex, race, body mass index, comorbid conditions, and concomitant medications of patients. All ARBs led to sustained reductions in BP, but with significant differences in the magnitude of BP reduction. Raw mean systolic BP/diastolic BP reductions with losartan, valsartan, irbesartan, and olmesartan were 9.3/4.9 mm Hg, 10.4/5.6 mm Hg, 10.1/5.3 mm Hg, and 12.4/6.8 mm Hg, respectively. Adjusting for all covariates, the overall BP reductions with olmesartan were 1.88/0.86 mm Hg, 1.21/0.52 mm Hg, and 0.89/0.51 mm Hg greater than for losartan, valsartan, and irbesartan, respectively, and mean differences were higher for monotherapy: 2.43/1.16mm Hg; 2.18/0.93 mm Hg; 1.44/0.91 mm Hg, respectively (all P values <.0001). Adjusted odds ratios of the JNC 7 goal attainment for losartan, valsartan, and irbesartan compared with olmesartan were 0.76, 0.86, and 0.91 (P<.05). Differences were also found in subpopulations: African Americans, diabetics, and obese/overweight patients but not all of these reached statistical significance. A broad choice of ARBs may be required to get patients to treatment goals.