Update on the VA cooperative study group on antihypertensive agents: monotherapy of hypertension trial.

The VA Cooperative Study Group on Antihypertensive Agents published its main findings in the NEJM 1993; 328:914-921. Subsequently, we discovered an error in the computer code that caused an underestimation of the percent success rates at one year. The corrected data were published in NEJM 1994;330:1689 and the corrected figures in Am J Hypertens 1995 (Feb) along with the data recalculated using a criterion of <90 mm Hg. A second part of the study looked at those 410 patients who failed treatment with the initial single drug. Of 352 who qualified for randomization to the alternate drug, 173 (49.1%) achieved goal DBP and 102 (29%) failed the alternate drug. This allowed us to conclude that sequential monotherapy was a viable alternative to stepped care. These data will be published in the Arch Intern Med in the fall of 1995. A third part of the study looked at combination therapy in the 102 patients who failed both single drugs. Combinations that included a diuretic achieved better results for both SBP and DBP than those that did not. The echo data have been published in regard to the interactions of obesity, age and race in J Am Coll Cardiol 1994;24:1492-98 and the results of drug-specific response favoring the diuretic are submitted. We are also looking at data on serum lipid changes by drug over time and we are looking at the patients with proteinuria.