Key result
Achieving systolic BP <135 mmHg cuts ESKD ~72%, while valsartan and amlodipine yield similar outcomes.
Why the study?
Data were lacking on how antihypertensive drug classes and blood pressure targets affect end-stage kidney disease incidence in high-risk hypertension.
Does valsartan compared to amlodipine, or achieving SBP <135 mmHg, reduce the incidence of end-stage kidney disease in patients with high-risk hypertension?
RCT (n=15,245)
Double-blind
Randomized
Yes
Does valsartan compared to amlodipine, or achieving SBP <135 mmHg, reduce the incidence of end-stage kidney disease in patients with high-risk hypertension?
Effect estimate: HR 1.02 (95% CI 0.68-1.52)
Absolute Event Rate: 0.61% vs 0.66%
p-value: p=0.94
Achieving a systolic blood pressure <135 mmHg provides significant kidney protection in high-risk hypertensive patients, while the choice between valsartan and amlodipine does not significantly impact ESKD incidence.
BACKGROUND: There is a paucity of data investigating the impact of antihypertensive drug classes and blood pressure (BP) treatment targets on the incidence of end-stage kidney disease (ESKD). In patients with high-risk hypertension aged 50-80 years or above, we aimed to, 1) compare effects of valsartan, an angiotensin receptor blocker, with amlodipine, a calcium channel blocker and, 2) assess the effect of achieving systolic BP <135 vs ≥135 mmHg on the ESKD incidence. METHODS: The VALUE Trial was a multicenter prospective double-blinded randomized clinical trial in patients with essential hypertension and high cardiovascular risk including known coronary disease, left ventricular hypertrophy and previous stroke, in which ESKD was a secondary endpoint defined as progression to kidney transplant and/or dialysis. Patients were randomized to either valsartan or amlodipine, with other anti-hypertensive medications as add-on if needed to reach the systolic BP target of <140 mmHg. Cox proportional hazards ratio (HR) was used to compare different treatment groups and achieved systolic BP <135 with ≥135 mmHg, during 3-6 years of follow-up. RESULTS: 15,245 patients were randomized and followed until 63,631 patient-years with only 90 patients lost to follow-up. The primary outcome, a composite of cardiac morbidity and mortality, was neutral between valsartan and amlodipine. On valsartan 47 patients (0.61 %) and on amlodipine 50 patients (0.66 %) developed ESKD (HR=1.02, 95 % CI 0.68-1.52, p =0.94). Achieved SBP <135 mmHg was strongly related to less ESKD (n =9/5036 patients, 0.2 %) compared with achieved SBP ≥135 mmHg (n =73/8766 patients, 0.8 %) (HR=0.28, CI 0.14-0.58, p <0.001). CONCLUSIONS: In hypertensive patients with a high cardiovascular risk, valsartan and amlodipine have a similar impact on the incidence of end-stage kidney disease. Achieving SBP <135 mmHg, averaging 128.8/77.3 mmHg, is highly efficacious in kidney protection.
No takes yet. Share an insight, caveat, or question.
Olsen et al. (2024) conducted an RCT in Essential hypertension and high cardiovascular risk (n=15,245). Valsartan vs. Amlodipine was evaluated on End-stage kidney disease (progression to kidney transplant and/or dialysis) (HR 1.02, 95% CI 0.68-1.52, p=0.94). Valsartan and amlodipine had similar effects on end-stage kidney disease incidence (HR 1.02; 95% CI 0.68-1.52), whereas achieving systolic BP <135 mmHg significantly reduced ESKD (HR 0.28; p<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: