According to the VAST study, patients with moderate to severe hypertension treated with a combination of Diovan ( Valsartan ) and the diuretic hydrochlorothiazide ( HCTZ ) (160/25) benefited from superior blood pressure reductions over those treated with Norvasc ( Amlodipine ) 10mg.

" We already know that Valsartan provides effective blood pressure-lowering and heart-saving benefits to people who have had a heart attack or have heart failure. Now these new data add to our understanding of Valsartan's efficacy in people with even earlier forms of heart disease," said Luis Ruilope, of the Hospital 12 de Octubre of Madrid, Spain, the primary investigator of VAST and an investigator for VALUE. " Large-scale trials have repeatedly shown that most high-risk patients with hypertension require aggressive treatment, either with a powerful monotherapy or more often with an effective fixed-dose combination, to reach healthy blood pressure goals."

Although cardiovascular disease ( CVD ) can be treated or prevented, according to the World Health Organization ( WHO ), across the globe around 17 million people die of CVD-related events each year, for which hypertension is a major contributing factor.
Also, alarmingly, of those patients with hypertension who are treated, nearly 7 out of 10 do not achieve the goal of 140/90 mmHg as recommended by treatment guidelines.
Patients with moderate to severe hypertension ( 160/100 mmHg ), such as those in VAST, are at four times greater risk for cardiovascular events than those with optimal blood pressure ( <120/80 mmHg ).

In a sub-study of VAST, a significantly greater proportion of patients treated with Diovan plus HCTZ 160/25 mg reached their blood pressure goal ( <130/80 mmHg, measured by ambulatory monitoring ) versus Amlodipine 10mg ( 60.8% Valsartan + HCTZ 160/25 mg vs. 48.4% Valsartan + HCTZ 160/12.5 mg vs. 50.9% Amlodipine 10mg; p<0.05 for Valsartan + HCTZ 160/25 mg vs. Amlodipine 10mg).

VAST ( Valsartan/HCTZ versus Amlodipine in STage II hypertensive patients with additional risk factors ) was a multicenter, multinational, randomized, double-blind, active-controlled, parallel group, 24-week study designed to evaluate the efficacy of Valsartan + HCTZ 160/12.5 mg, Valsartan + HCTZ 160/25 mg and Amlodipine 10 mg on systolic blood pressure in a broad population of 1,088 patients with moderate to severe high blood pressure and additional cardiovascular risk factors.
Mean systolic blood pressure at baseline was 167 mmHg, 166 mmHg, 166 mmHg for Valsartan + HCTZ 160/12.5 mg, Valsartan + HCTZ 160/25 mg and Amlodipine, respectively. The mean diastolic blood pressure at baseline was 94 mmHg, 93 mmHg and 94 mmHg respectively.

Valsartan + HCTZ 160/25 mg demonstrated superior efficacy in reducing systolic blood pressure vs. Amlodipine 10mg ( p<0.05 ). Mean changes in blood pressure were: -29.7 +0.7 mmHg, 27.1 +0.7 mmHg and 27.6 +0.7 mmHg for the Valsartan + HCTZ 160/25 mg, Valsartan + HCTZ 160/12.5 mg and Amlodipine groups, respectively.
The difference in diastolic blood pressure between the groups was not statistically significant. Both Valsartan + HCTZ 160/25 mg and 160/12.5 mg compared with Amlodipine 10mg had a significantly lower rate of treatment-related adverse events (15.4% and 13.9% respectively vs. 42.7%; p<0.05).

Source: 15th European Meeting on Hypertension, 2005


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