Modelling of blood pressure and total cardiovascular risk outcomes after second-line valsartan therapy: The BSCORE study

Robert Lins, Nicolas Coen, Ann Aerts, Karen MacDonald, Heidi Brié, Christine Hermans, Yu Ming Shen, Christopher Lee, Stefaan Vancayzeele, Natalie Mecum, Ivo Abraham

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: European guidelines recommend that antihypertensive management should be graded as a function of total cardiovascular risk. Aims: To examine the multilevel (patient- and physician-level) determinants of blood pressure and residual total cardiovascular risk outcomes associated with second-line valsartan therapy. Methods: The BSCORE study was a prospective, multi-centre, pharmacoepidemiological study of the "real-world" effectiveness of second-line valsartan with or without hydrochlorothiazide. Results: A total of 3497 patients were recruited by 354 physicians. Mean age was 63.8 ± 12.0 years; 52.3% were male; 20.9% were smokers; 47.7% were dyslipidaemic; and 23.6% had diabetes. On average, reductions in blood pressure and increases in the proportions of patients with controlled blood pressure after 90 days were statistically significant (all P < 0.001). Twenty-one percent of systolic blood pressure and 25.6% of diastolic blood pressure variability at follow-up was attributable to physician-level characteristics. Significant reductions in total cardiovascular risk were observed (P < 0.001); with 12.5% of the variability in total cardiovascular risk change attributable to physician-level characteristics. Several independent determinants of blood pressure outcomes were identified, many of which are modifiable. Conclusions: Second-line valsartan therapy improves blood pressure outcomes under variable real-world conditions, and is associated with a decrease in total cardiovascular risk. Optimizing antihypertensive effectiveness, including the reduction of residual cardiovascular risk, involves managing concomitant conditions and risk factors, improving adherence, and identifying physician-level factors amenable to intervention.

Original languageEnglish (US)
Pages (from-to)428-434
Number of pages7
JournalArchives of Cardiovascular Diseases
Issue number8-9
StatePublished - Aug 2011
Externally publishedYes


  • Angiotensin II type 1
  • Blood pressure
  • Hypertension
  • Receptor blockers
  • Treatment effectiveness
  • Valsartan

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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