Baseline characteristics and early blood pressure control in the CONVINCE trial

Blood pressure (BP) control rates around the world are suboptimal, Part 2 o f the National Health and Nutrition Educational Survey (NHANES) III indicat es that only 27.4% of hypertensive Americans aged 18 to 74 years have a BP of <140/90 mm Hg, We wanted to assess BP control during the first 2 years a nd to describe the baseline characteristics of patients enrolled in the Con trolled ONset Verapamil INvestigation of Cardiovascular Endpoints (CONVINCE ) Study, an international clinical trial that compares outcomes in hyperten sive patients randomized to initial treatment with either controlled-onset extended-release verapamil or the investigator's choice of atenolol or hydr ochlorothiazide. At randomization, BP was <140/90 mm Hg in only 20.3% of th e 16 602 subjects (average+/-SD age 65.6+/-7.4 years; 56% women, 84% white/ 7% black/7% Hispanic). The average BP at enrollment was 148/85 mm Hg for pa tients taking BP medications (n=13 879) and 161/94 mm Hg for previously unt reated patients (n=2723). After medication titration, with a transtelephoni c computer that recommended an increase in the dose or number of antihypert ensive agents whenever the BP was 140/90 mm Hg, 84.8% of the subjects attai ned the goal BP, During 2 years of treatment, BP control was maintained in 67% to 69% of the subjects (69% to 71% for systolic BP of <140 mm Hg and 90 % for diastolic BP of <90 mm Hg). These data suggest that the control of sy stolic BP is more difficult than the control of diastolic BP. The US nation al goal of having 50% of hypertensives with a BP of <140/90 mm Hg may be ac hievable if a forced titration strategy is used. Interested investigators, free care and medications, and well-educated subjects may make the attainme nt of such a goal easier in the CONVINCE study than in the general populati on.