VALUE研究和MATCH研究课件.pptxVIP

VALUEandMATCH:Aneraofcomparativeclinicaltrialsdown–July2004EricJTopolMDProvostandChiefAcademicOfficerChairman,DepartmentofCardiovascularMedicineClevelandClinicFoundationCleveland,OHRobertMCaliffMDProfessorofMedicineAssociateViceChancellorforClinicalResearchDirector,DukeClinicalResearchInstituteDukeUniversityMedicalCenterDurham,NCThumbsup/Thumbs

TopicsThumbsup/Thumbsdown–July2004VALUEValsartan Antihypertensive Long-TermUse EvaluationMATCHManagement of Atherothrombosis withClopidogrel in High-Risk Patients withRecent Transient Ischemic Attacks orIschemic Stroke

ValsartanLong-TermThumbsup/Thumbsdown–July2004AntihypertensiveUse EvaluationVALUE

VALUE:GoalThumbsup/Thumbsdown–July2004Trialdesignedtocomparetwotreatmentstrategiesamlodipine(Norvasc ?,Pfizer)andvalsartan(Diovan ?,Novartis).(Lancet 2004Jun19;363:2022-31.)STUDYAIM?Ifsimilarblood-pressurecontrolcouldbeachievedwithbothdrugs,wouldtherebeanybeneficialeffectoncardiacendpointswithvalsartanbeyondblood-pressureloweringalone??Primaryendpointacompositeofcardiacmorbidityormortality

VALUE:DesignThumbsup/Thumbsdown–July2004?Trialinvolved15245hypertensivepatientswithatleastonehigh-riskfeature,includingCAD,previousstrokeorTIA,peripheralvasculardisease,ordiabetes?Patientsrandomizedtovalsartan80mgoramlodipine5mg?PatientsalreadyonBP-loweringmedicationsrolledovertoeitheramlodipineorvalsartan?Atonemonth,iftargetBPnot140/90mmHg,patientsup-titratedtovalsartan160mgandamlodipine10mg;hydrochlorothiazideaddedinincreasingdosesifcontrolnotachieved

VALUE:PrimarycompositeendpointLancet2Thumbsup/Thumbsdown–July2004EndpointValsartanAmlodipineHazardratio(95%CI)Primary810(10.6)789(10.4)1.04composite,n(%)(0.94-1.15)Cardiac304(4.0)304(4.0)1.01mortality,n(%)(0.86-1.18)Cardiac586(7.7)578(7.6)1.02morbidity,n(%)(0.91-1.15)

VALUE:Systol