Predicting age- and dose-related responses to antihypertensive therapy: pooled analysis of two randomized clinical trials of valsartan alone and combined with hydrochlorothiazide

We evaluated the relationship between age and treatment response from pooled data from two randomized trials in which 1,464 patients with Stage 2 hypertension were treated with valsartan alone or in combination with hydrochlorothiazide (HCTZ). Multivariate models were constructed for two response variables: systolic blood pressure (SBP) achieved at week 8 and change from baseline in SBP at week 8. Increasing age and higher baseline SBP were associated with proportionally higher final SBP values. The highly significant age-related decline in treatment response was substantially reduced with valsartan plus HCTZ compared with valsartan alone. Adverse event rates were generally comparable across the treatment groups. This analysis indicates that both age and baseline SBP should be considered when selecting antihypertensive therapy for patients with Stage 2 hypertension; for many older patients, initial therapy with both valsartan and HCTZ may be necessary, but in younger patients, one drug may be appropriate. However, because >87% of the study participants were White, it is unclear whether these results are applicable to other ethnic groups.