EFFECTS OF VALSARTAN VS AMLODIPINE ON THE INCIDENCE OF END-STAGE KIDNEY DISEASE IN HIGH-RISK HYPERTENSION: THE VALUE TRIAL

Objective: There is a paucity of data investigating the impact of antihypertensive drug classes on the incidence of end-stage kidney disease (ESKD). In patients with high-risk hypertension aged 50-80 years or above, we aimed to compare effects of valsartan, an angiotensin receptor blocker, with amlodipine, a calcium channel blocker on the ESKD incidence.Design and method: The VALUE Trial was a multicenter prospective double-blinded randomized clinical trial in patients with essential hypertension and high cardiovascular risk including known coronary disease, left ventricular hypertrophy and previous stroke, in which ESKD was a secondary endpoint defined as progression to kidney transplant and/or dialysis. Patients were randomized to either valsartan or amlodipine, with other anti-hypertensive medications as add-on if needed to reach the systolic BP target of <140 mmHg. Cox proportional hazards ratio (HR) was used to compare different treatment during 3-6 years of follow-up. Results: 15,245 patients were randomized and followed until 63,631 patient-years with only 90 patients lost to follow-up. The primary outcome, a composite of cardiac morbidity and mortality, was neutral between valsartan and amlodipine. On valsartan 47 patients (0.61%) and on amlodipine 50 patients (0.66%) developed ESKD (HR=1.02, 95% CI 0.68-1.52, p=0.94). Conclusions: In hypertensive patients with a high cardiovascular risk, valsartan and amlodipine have a similar impact on the incidence of end-stage kidney disease (Figure).