Targeting hypertension with Valsartan: Lessons learned from the Valsartan/HCTZ versus amlodipine in stage II hypertensive patients (VAST) trial

Many patients with hypertension, especially those at increased risk because of additional cardiovascular risk factors, require treatment with more than one antihypertensive agent to achieve target blood pressure (BP) goals. Many different classes of antihypertensive agents are available: a renin-angiotensin-aldosterone system (RAAS) blocker and a diuretic are widely used in combination. Here we report the results of the recently completed Valsartan/HCTZ versus Amlodipine in STage II hypertensive patients (VAST) trial. In this 24-week study, patients with moderate hypertension and at least one other cardiovascular risk factor were treated with a combination of valsartan 160 mg and hydrochlorothiazide (HCTZ) 12.5 or 25 mg once daily (o.d.), or with amlodipine monotherapy (10 mg o.d.). Overall, valsartan plus HCTZ 25 mg reduced systolic BP significantly more than amlodipine monotherapy, and with fewer adverse events. In addition, combination therapy resulted in a trend towards more favourable outcomes with respect to pro-thrombotic and pro-inflammatory markers than amlodipine alone.