Heart, Lung and Circulation

Optimising Primary Care Management of Hypertension: The Valsartan Intensified Primary Care Reduction of Blood Pressure (VIPER-BP) Study

      Background: We undertook Australia's largest ever randomised trial of integrated BP and risk reduction management (involving automated absolute risk profiling, standardised pharmacological treatment and computer assisted, intensified follow-up and treatment titration).
      Methods: VIPER-BP is a multicentre, open-label, randomised controlled trial in GP clinics throughout Australia comparing usual GP management with an intensive BP management strategy using three forms of valsartan-based therapy. The primary endpoint is individualised BP control at six months.
      Results: During recruitment 2334 patients initially screened. Of these, 2131 (91%) commenced a 28 day valsartan 80 mg “run-in” phase. Subsequently, 310 patients achieved their individual BP target (15%) whilst 81 patients (5.2%) were rescue randomised. Overall, 1555 patients were randomised to usual care (n = 519) or the VIPER-BP Intervention (n = 1036): comprising 948 men (62%) and 607 women (aged 59 ± 12 vs. 60 ± 12 years, respectively) and 1004 patients (65%) previously treated for hypertension. Individual BP targets (systolic/diastolic BP) were as follows; 125/75 mm Hg (18% with proteinuria), 130/80 mm Hg (55% with diabetes or CVD) and 140/90 mm Hg (27%). Mean BP at randomisation was 149 ± 17/88 ± 11 mm Hg with similar BP profiles for men and women, respectively (149 ± 16/88 ± 11 versus 149 ± 17/87 ± 10 mm Hg).
      Conclusion: With study completion in August 2011, the VIPER-BP Study will provide invaluable insights into the most effective means to optimise BP levels (on an individualised basis) in the primary care setting.