Progressive effects of valsartan compared with amlodipine in prevention of diabetes according to categories of diabetogenic risk in hypertensive patients: The VALUE trial

Sverre E. Kjeldsen, Gordon T. Mcinnes, Giuseppe Mancia, Tsushung A. Hua, Stevo Julius, Michael A. Weber, Antonio Coca, Xavier Girerd, Kenneth Jamerson, Pierre Larochelle, Thomas Macdonald, Roland E. Schmieder, M. Anthony Schork, Reuven Viskoper, Jiri Widimsky, Alberto Zanchetti, Value Trial Investigators

    Research output: Contribution to journalArticle

    12 Citations (Scopus)

    Abstract

    We have previously shown that the angiotensin receptor blocker valsartan is associated with a lower incidence of new-onset type 2 diabetes than that with the calcium-channel antagonist amlodipine in the treatment of hypertensive patients at high cardiovascular risk. We have now investigated the benefits of valsartan vs amlodipine in patients of different categories of diabetogenic risk. Some 9995 patients without diabetes at onset participated in VALUE, with average follow-up of 4.2 years. Predictors of new diabetes were analyzed by stepwise logistic regression. A diabetes risk score for each patient was calculated based on a multivariate model. The risk of developing new diabetes in quartiles of risk for the disease was calculated as an odds ratio (OR) with 95% confidence intervals (CI). New diabetes was reported in 580 (11.5%) patients on valsartan and in 718 (14.5%) patients on amlodipine (p<0.0001). There was a more than sevenfold rise in the development of new diabetes from the lowest to the highest quartile of risk. When study treatment was included in the risk model, the odds in favor of valsartan in preventing new diabetes progressively increased with higher risk. Fifty-two (4.03%) patients developed diabetes on valsartan and 50 (4.14%) patients on amlodipine in the lowest quartile of risk, 73 (5.70%) patients on valsartan and 83 (6.81%) patients on amlodipine in the second quartile, and 126 (10.27%) patients on valsartan and 160 (12.58%) patients on amlodipine in the third quartile. The difference between treatments was highly significant in quartile 4 with 329 (26.68%) patients developing new diabetes on valsartan vs 425 (33.57%) patients on amlodipine (OR=0.72, 95% CI 0.61-0.86, p=0.0002). The number of patients needed for treatment for the duration of the trial in order to gain the benefit of valsartan over amlodipine in preventing one new case of diabetes was 43 in the third quartile and 15 in the fourth quartile of risk categories. We conclude that valsartan compared with amlodipine reduces the risk of developing diabetes mellitus, particularly in hypertensive patients with the highest susceptibility for development of diabetes.

    Original languageEnglish
    Pages (from-to)170-177
    Number of pages8
    JournalBlood Pressure
    Volume17
    Issue number3
    DOIs
    Publication statusPublished - 2008

    Keywords

    • amlodipine
    • blood pressure
    • diabetes
    • hypertension
    • prevention
    • valsartan
    • CONVERTING-ENZYME-INHIBITOR
    • LIPID-LOWERING TREATMENT
    • HIGH CARDIOVASCULAR RISK
    • CALCIUM-CHANNEL BLOCKER
    • END-POINT REDUCTION
    • RANDOMIZED-TRIAL
    • LOSARTAN INTERVENTION
    • ANGIOTENSIN-II
    • MORBIDITY
    • MORTALITY

    Cite this

    Kjeldsen, Sverre E. ; Mcinnes, Gordon T. ; Mancia, Giuseppe ; Hua, Tsushung A. ; Julius, Stevo ; Weber, Michael A. ; Coca, Antonio ; Girerd, Xavier ; Jamerson, Kenneth ; Larochelle, Pierre ; Macdonald, Thomas ; Schmieder, Roland E. ; Schork, M. Anthony ; Viskoper, Reuven ; Widimsky, Jiri ; Zanchetti, Alberto ; Value Trial Investigators. / Progressive effects of valsartan compared with amlodipine in prevention of diabetes according to categories of diabetogenic risk in hypertensive patients: The VALUE trial. In: Blood Pressure. 2008 ; Vol. 17, No. 3. pp. 170-177.
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    abstract = "We have previously shown that the angiotensin receptor blocker valsartan is associated with a lower incidence of new-onset type 2 diabetes than that with the calcium-channel antagonist amlodipine in the treatment of hypertensive patients at high cardiovascular risk. We have now investigated the benefits of valsartan vs amlodipine in patients of different categories of diabetogenic risk. Some 9995 patients without diabetes at onset participated in VALUE, with average follow-up of 4.2 years. Predictors of new diabetes were analyzed by stepwise logistic regression. A diabetes risk score for each patient was calculated based on a multivariate model. The risk of developing new diabetes in quartiles of risk for the disease was calculated as an odds ratio (OR) with 95{\%} confidence intervals (CI). New diabetes was reported in 580 (11.5{\%}) patients on valsartan and in 718 (14.5{\%}) patients on amlodipine (p<0.0001). There was a more than sevenfold rise in the development of new diabetes from the lowest to the highest quartile of risk. When study treatment was included in the risk model, the odds in favor of valsartan in preventing new diabetes progressively increased with higher risk. Fifty-two (4.03{\%}) patients developed diabetes on valsartan and 50 (4.14{\%}) patients on amlodipine in the lowest quartile of risk, 73 (5.70{\%}) patients on valsartan and 83 (6.81{\%}) patients on amlodipine in the second quartile, and 126 (10.27{\%}) patients on valsartan and 160 (12.58{\%}) patients on amlodipine in the third quartile. The difference between treatments was highly significant in quartile 4 with 329 (26.68{\%}) patients developing new diabetes on valsartan vs 425 (33.57{\%}) patients on amlodipine (OR=0.72, 95{\%} CI 0.61-0.86, p=0.0002). The number of patients needed for treatment for the duration of the trial in order to gain the benefit of valsartan over amlodipine in preventing one new case of diabetes was 43 in the third quartile and 15 in the fourth quartile of risk categories. We conclude that valsartan compared with amlodipine reduces the risk of developing diabetes mellitus, particularly in hypertensive patients with the highest susceptibility for development of diabetes.",
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    author = "Kjeldsen, {Sverre E.} and Mcinnes, {Gordon T.} and Giuseppe Mancia and Hua, {Tsushung A.} and Stevo Julius and Weber, {Michael A.} and Antonio Coca and Xavier Girerd and Kenneth Jamerson and Pierre Larochelle and Thomas Macdonald and Schmieder, {Roland E.} and Schork, {M. Anthony} and Reuven Viskoper and Jiri Widimsky and Alberto Zanchetti and {Value Trial Investigators}",
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    language = "English",
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    Kjeldsen, SE, Mcinnes, GT, Mancia, G, Hua, TA, Julius, S, Weber, MA, Coca, A, Girerd, X, Jamerson, K, Larochelle, P, Macdonald, T, Schmieder, RE, Schork, MA, Viskoper, R, Widimsky, J, Zanchetti, A & Value Trial Investigators 2008, 'Progressive effects of valsartan compared with amlodipine in prevention of diabetes according to categories of diabetogenic risk in hypertensive patients: The VALUE trial', Blood Pressure, vol. 17, no. 3, pp. 170-177. https://doi.org/10.1080/08037050802169644

    Progressive effects of valsartan compared with amlodipine in prevention of diabetes according to categories of diabetogenic risk in hypertensive patients: The VALUE trial. / Kjeldsen, Sverre E.; Mcinnes, Gordon T.; Mancia, Giuseppe; Hua, Tsushung A.; Julius, Stevo; Weber, Michael A.; Coca, Antonio; Girerd, Xavier; Jamerson, Kenneth; Larochelle, Pierre; Macdonald, Thomas; Schmieder, Roland E.; Schork, M. Anthony; Viskoper, Reuven; Widimsky, Jiri; Zanchetti, Alberto; Value Trial Investigators.

    In: Blood Pressure, Vol. 17, No. 3, 2008, p. 170-177.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Progressive effects of valsartan compared with amlodipine in prevention of diabetes according to categories of diabetogenic risk in hypertensive patients: The VALUE trial

    AU - Kjeldsen, Sverre E.

    AU - Mcinnes, Gordon T.

    AU - Mancia, Giuseppe

    AU - Hua, Tsushung A.

    AU - Julius, Stevo

    AU - Weber, Michael A.

    AU - Coca, Antonio

    AU - Girerd, Xavier

    AU - Jamerson, Kenneth

    AU - Larochelle, Pierre

    AU - Macdonald, Thomas

    AU - Schmieder, Roland E.

    AU - Schork, M. Anthony

    AU - Viskoper, Reuven

    AU - Widimsky, Jiri

    AU - Zanchetti, Alberto

    AU - Value Trial Investigators

    PY - 2008

    Y1 - 2008

    N2 - We have previously shown that the angiotensin receptor blocker valsartan is associated with a lower incidence of new-onset type 2 diabetes than that with the calcium-channel antagonist amlodipine in the treatment of hypertensive patients at high cardiovascular risk. We have now investigated the benefits of valsartan vs amlodipine in patients of different categories of diabetogenic risk. Some 9995 patients without diabetes at onset participated in VALUE, with average follow-up of 4.2 years. Predictors of new diabetes were analyzed by stepwise logistic regression. A diabetes risk score for each patient was calculated based on a multivariate model. The risk of developing new diabetes in quartiles of risk for the disease was calculated as an odds ratio (OR) with 95% confidence intervals (CI). New diabetes was reported in 580 (11.5%) patients on valsartan and in 718 (14.5%) patients on amlodipine (p<0.0001). There was a more than sevenfold rise in the development of new diabetes from the lowest to the highest quartile of risk. When study treatment was included in the risk model, the odds in favor of valsartan in preventing new diabetes progressively increased with higher risk. Fifty-two (4.03%) patients developed diabetes on valsartan and 50 (4.14%) patients on amlodipine in the lowest quartile of risk, 73 (5.70%) patients on valsartan and 83 (6.81%) patients on amlodipine in the second quartile, and 126 (10.27%) patients on valsartan and 160 (12.58%) patients on amlodipine in the third quartile. The difference between treatments was highly significant in quartile 4 with 329 (26.68%) patients developing new diabetes on valsartan vs 425 (33.57%) patients on amlodipine (OR=0.72, 95% CI 0.61-0.86, p=0.0002). The number of patients needed for treatment for the duration of the trial in order to gain the benefit of valsartan over amlodipine in preventing one new case of diabetes was 43 in the third quartile and 15 in the fourth quartile of risk categories. We conclude that valsartan compared with amlodipine reduces the risk of developing diabetes mellitus, particularly in hypertensive patients with the highest susceptibility for development of diabetes.

    AB - We have previously shown that the angiotensin receptor blocker valsartan is associated with a lower incidence of new-onset type 2 diabetes than that with the calcium-channel antagonist amlodipine in the treatment of hypertensive patients at high cardiovascular risk. We have now investigated the benefits of valsartan vs amlodipine in patients of different categories of diabetogenic risk. Some 9995 patients without diabetes at onset participated in VALUE, with average follow-up of 4.2 years. Predictors of new diabetes were analyzed by stepwise logistic regression. A diabetes risk score for each patient was calculated based on a multivariate model. The risk of developing new diabetes in quartiles of risk for the disease was calculated as an odds ratio (OR) with 95% confidence intervals (CI). New diabetes was reported in 580 (11.5%) patients on valsartan and in 718 (14.5%) patients on amlodipine (p<0.0001). There was a more than sevenfold rise in the development of new diabetes from the lowest to the highest quartile of risk. When study treatment was included in the risk model, the odds in favor of valsartan in preventing new diabetes progressively increased with higher risk. Fifty-two (4.03%) patients developed diabetes on valsartan and 50 (4.14%) patients on amlodipine in the lowest quartile of risk, 73 (5.70%) patients on valsartan and 83 (6.81%) patients on amlodipine in the second quartile, and 126 (10.27%) patients on valsartan and 160 (12.58%) patients on amlodipine in the third quartile. The difference between treatments was highly significant in quartile 4 with 329 (26.68%) patients developing new diabetes on valsartan vs 425 (33.57%) patients on amlodipine (OR=0.72, 95% CI 0.61-0.86, p=0.0002). The number of patients needed for treatment for the duration of the trial in order to gain the benefit of valsartan over amlodipine in preventing one new case of diabetes was 43 in the third quartile and 15 in the fourth quartile of risk categories. We conclude that valsartan compared with amlodipine reduces the risk of developing diabetes mellitus, particularly in hypertensive patients with the highest susceptibility for development of diabetes.

    KW - amlodipine

    KW - blood pressure

    KW - diabetes

    KW - hypertension

    KW - prevention

    KW - valsartan

    KW - CONVERTING-ENZYME-INHIBITOR

    KW - LIPID-LOWERING TREATMENT

    KW - HIGH CARDIOVASCULAR RISK

    KW - CALCIUM-CHANNEL BLOCKER

    KW - END-POINT REDUCTION

    KW - RANDOMIZED-TRIAL

    KW - LOSARTAN INTERVENTION

    KW - ANGIOTENSIN-II

    KW - MORBIDITY

    KW - MORTALITY

    U2 - 10.1080/08037050802169644

    DO - 10.1080/08037050802169644

    M3 - Article

    VL - 17

    SP - 170

    EP - 177

    JO - Blood Pressure

    JF - Blood Pressure

    SN - 0803-7051

    IS - 3

    ER -