Gender-stratified hierarchical modeling of patient and physician determinants of antihypertensive treatment outcomes: pooled analysis of seven prospective real-world studies with 17,044 patients

Abstract

Objective

Seven prospective real-world studies conducted in general practices in Belgium of antihypertensive treatment with valsartan-centric regimens were pooled to examine similarities and differences in determinants of blood pressure (BP) values (mmHg) and BP control rates between female and male patients.

Methods

Pooled analysis of a total evaluable sample of 17,044 patients, including 8273 (48.5%) women and 8771 men (51.5%) treated over approximately 90 days with valsartan-centric regimens in second or later line. Hierarchical linear and logistic regressions were applied to identify patient- and physician-related determinants of BP outcomes and a potential physician class effect.

Results

Reductions in BP (mmHg) over 90 days were similar for women and men, and so were changes in BP control rates. Approximately a quarter of the variance in 90 day BP values was attributable to a physician class effect. Both gender groups shared some patient- and physician-related determinants of BP outcomes, though often varying in degree of influence. Analyses also revealed gender-specific determinants. Among others, modifiable/manageable patient-related determinants included BP at hypertension diagnosis (proxy for time of diagnosis), risk factors, antihypertensive treatment and adherence; while among the physician-related determinants clinical experience in hypertension treatment was modifiable/manageable.

Conclusion

Valsartan-centric treatment regimens are associated with significant reductions in BP level and improvement in BP control in both women and men. The determinants revealed in modeling provide guidance to clinicians in the common and differential management of hypertension in female and male patients.

Keywords:

• Angiotensin II receptor blockers
• effectiveness
• hypertension
• outcomes
• valsartan
• gender

Transparency

Declaration of funding

The seven studies in this pooled analysis were sponsored by Novartis Pharma (Belgium) through research contracts to Matrix45. For this paper, statistical analysis and manuscript development were done independently from the sponsor and without funding. Novartis had right of review and comment. Authors employed by Novartis refrained from undue influence. Any issues related to results or manuscript were addressed by the external authors.

Declaration of financial/other relationships

I.A., K.D. and K.M. are affiliated with Matrix45. By company policy, they cannot hold equity in sponsor and client companies, nor perform services or receive compensation independently from sponsor and client organizations. H.B. and S.V. are employees of Novartis and own equity in Novartis. No potential conflict of interest was reported by D.H. or N.A.

Author contributions

Study concept and design: I.A., H.B., K.M., S.V. Data acquisition and management: H.B., K.D., K.M. Statistical analysis: I.A., K.D., K.M. Tabulation of results: I.A., N.A., K.D., D.H., K.M. Interpretation of results: All authors. Manuscript writing: I.A., N.A., K.D., D.H. Critical review of manuscript for scientific content: All authors.

Acknowledgements

D.H. is now at Ro’ya Tholathiyat Al Aba’d (Amman, Jordan). Writing and editorial services were provided pro bono by Matrix45.