Advances in Therapy

, 28:789 | Cite as

Blood pressure control rates with an antihypertensive regimen including trandolapril in a canadian usual-care setting

  • Richard H. TytusEmail author
  • Linda Assouline
  • Anita Vanjaka
Original Research



The aim of the study was to assess the effects on blood pressure (BP) levels and control rates in hypertensive subjects receiving trandolapril as monotherapy or as part of an antihypertensive regimen in everyday Canadian clinical practice.


The MAVIKtory study was a multicenter, single-arm observational study in 601 primary-care centers in Canada. Diabetic and nondiabetic subjects were included, who were treated with trandolapril for hypertension in accordance with usual practices and national guidelines. Subjects received trandolapril as a new prescription, alone, or in combination with prior therapy. Treatment regimens were at the discretions of the treating physicians. Subjects were followed for 6 months. The primary outcomes measures were the percentage of subjects reaching BP targets set by their physicians after 6 months of therapy, and the percentage of subjects reaching the guidelines targets (systolic blood pressure [SBP]/diastolic blood pressure [DBP] <140/90 mm Hg) after 6 months as assessed by their physicians. Other outcomes were the percentage of diabetic subjects reaching BP targets, and tolerability.


A total of 8787 subjects were enrolled and included in the intention-to-treat population. Starting doses of trandolapril were 1 or 2 mg in the majority of subjects and remained unchanged in 51.9% of the population at 6 months. The target of <140/90 (<130/80) mm Hg was reached by 67.3% of the population. The lower mean physician-set target of 133.4/83.3 mm Hg for nondiabetic subjects and 128.6/79.3 mm Hg for diabetic subjects was reached by 52.2%. Mean reductions from baseline to month 6 were 19.4 mm Hg (95% CI: [−19.9 to −19.0]) in SBP, and 10.1 mm Hg (95% CI: [−10.4 to −9.8]) in DBP. Cough was the most commonly reported adverse event, reported in 4.2% of all subjects.


Trandolapril demonstrated a favorable safety and effectiveness profile. SBP reductions of approximately 20 mm Hg and control rates >65% could be achieved over 6 months.


antihypertensive hypertension real-life clinical practice trandolapril 


  1. 1.
    Berenson GS, Srinivasan SR, Bao W, Newman WP III, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. 1998;338:1650–1656.PubMedCrossRefGoogle Scholar
  2. 2.
    Thompson DW, Furlan AJ. Clinical epidemiology of stroke. Neurol Clin. 1996;14:309–315.PubMedCrossRefGoogle Scholar
  3. 3.
    World Health Organisation. The world health report 2002. Reducing risks, promoting healthy life. Geneva: The World Health Organisation; 2002.Google Scholar
  4. 4.
    Murray CJ, Lopez AD. Evidence based health policy - lessons from the Global Burden of Disease Study. Science. 1996;274:740–743.PubMedCrossRefGoogle Scholar
  5. 5.
    Murray CJ, Lopez AD. Global mortality, disability and the contribution of risk factors: Global Burden of Disease Study. Lancet. 1997;349:1436–1446.PubMedCrossRefGoogle Scholar
  6. 6.
    Joffres MR, Hamet P, MacLean DR, L’italien GJ, Fodor G. Distribution of blood pressure and hypertension in Canada and the United States. Am J Hypertens. 2001;14:1099–1105.PubMedCrossRefGoogle Scholar
  7. 7.
    Califf RM. A virtuous cycle to improve hypertension outcomes at a national level: linking public health and individualized medicine. Hypertension. 2009;53:105–107.PubMedCrossRefGoogle Scholar
  8. 8.
    Campbell NR, Brant R, Johansen H, et al. Canadian Hypertension Education Program Outcomes Research Task Force. Increases in antihypertensive prescriptions and reductions in cardiovascular events in Canada. Hypertension. 2009;53:128–134.PubMedCrossRefGoogle Scholar
  9. 9.
    Campbell NR, So L, Amankwah E, Quan H, Maxwell C. Canadian Hypertension Education Program Outcomes Research Task Force. Characteristics of hypertensive Canadians not receiving drug therapy. Can J Cardiol. 2008;24:485–490.PubMedCrossRefGoogle Scholar
  10. 10.
    Petrella RJ, Campbell NRC. Awareness and misconception of hypertension in Canada: Results of a national survey. Can J Cardiol. 2005;21:589–593.PubMedGoogle Scholar
  11. 11.
    The 2010 Canadian Hypertension Education Program Recommendations (CHEP). Available at: Accessed June 10, 2011.
  12. 12.
    Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. 2008;359:2417–2428.PubMedCrossRefGoogle Scholar
  13. 13.
    Andrade SE, Walker AM, Gottlieb LK, et al. Discontinuation of antihyperlipidemic drugs - do rates reported in clinical trials reflect rates in primary care settings? N Engl J Med. 1995;332:1125–1131.PubMedCrossRefGoogle Scholar
  14. 14.
    Cardinal H, Monfared AA, Dorais M, Lelorier J. A comparison between persistence to therapy in ALLHAT and in everyday clinical practice: a generalizability issue. Can J Cardiol. 2004;20:417–421.PubMedGoogle Scholar
  15. 15.
    Guay DR. Trandolapril: a newer angiotensin-converting enzyme inhibitor. Clin Ther. 2003;25:713–715.PubMedCrossRefGoogle Scholar
  16. 16.
    Tytus R, Burgess E, Assouline L, Vanjaka A. A 26-week, prospective, open-label, uncontrolled, multicenter study to evaluate the effect of an escalating-dose regimen of trandolapril on change in blood pressure in treatment-naive and concurrently treated adult hypertensive subjects (TRAIL). Clin Ther. 2007;29:305–315.PubMedCrossRefGoogle Scholar
  17. 17.
    Tytus RH, Burgess ED, Assouline L, Vanjaka A. Effectiveness of a trandolapril-based treatment regimen in subjects with isolated systolic hypertension in Canada. Curr Med Res Opin. 2009;25:1379–1384.PubMedCrossRefGoogle Scholar
  18. 18.
    Biswas PN, Wilton LV, Shakir SW. The safety of valsartan: results of a postmarketing surveillance study on 12 881 patients in England. J Hum Hypertens. 2002;16:795–803.PubMedCrossRefGoogle Scholar
  19. 19.
    Black N. Why we need observational studies to evaluate the effectiveness of health care. BMJ. 1996;312:1215–1218.PubMedGoogle Scholar
  20. 20.
    Greener M. Drug safety on trial. EMBO Rep. 2005;6:202–204.PubMedCrossRefGoogle Scholar
  21. 21.
    Baker WL, Coleman CI, Kluger J, et al. Systematic review: comparative effectiveness of angiotensin-converting enzyme inhibitors or angiotensin II-receptor blockers for ischemic heart disease. Ann Intern Med. 2009;151:861–871.PubMedGoogle Scholar
  22. 22.
    Bent S, Padula A, Avins AL. Better ways to question patients about adverse medical events: a randomized, controlled trial. Ann Intern Med. 2006;144:257–261.PubMedGoogle Scholar
  23. 23.
    Matchar DB, McCrory DS, Orlando LA, et al. Systematic review: comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treating essential hypertension. Ann Intern Med. 2008;148:16–29.PubMedGoogle Scholar
  24. 24.
    Stergiou, G. DEMANT. Data presented at the European Society of Hypertension annual meeting. Milan, Italy, June 29th, 2011.Google Scholar
  25. 25.
    Lachaine J, Petrella RJ, Merikle E, Ali F. Choices, persistence and adherence to antihypertensive agents: evidence from RAMQ data. Can J Cardiol. 2008;24:269–273.PubMedCrossRefGoogle Scholar
  26. 26.
    Jones JK, Gorkin L, Lian JF, Staffa JA, Fletcher AP. Discontinuation of and changes in treatment after start of new courses of antihypertensive drugs: a study of a United Kingdom population. BMJ. 1995;311:293–295.PubMedGoogle Scholar
  27. 27.
    Caro JJ, Speckman JL, Salas M, Raggio G, Jackson JD. Effect of initial drug choice on persistence with antihypertensive therapy: the importance of actual practice data. CMAJ. 1999;160:41–46.PubMedGoogle Scholar
  28. 28.
    Burnier M, Hess B, Greminger P, Waeber B. Determinants of persistence in hypertensive patients treated with irbesartan: results of a postmarketing survey. BMC Cardiovasc Disord. 2005;5:13.PubMedCrossRefGoogle Scholar
  29. 29.
    Marentette MA, Gerth WC, Billings DK, Zarnke KB. Antihypertensive persistence and drug class. Can J Cardiol. 2002;18:649–656.PubMedGoogle Scholar

Copyright information

© Springer Healthcare 2011

Authors and Affiliations

  • Richard H. Tytus
    • 1
    • 2
    Email author
  • Linda Assouline
    • 3
  • Anita Vanjaka
    • 3
  1. 1.Hamilton Health SciencesHamiltonCanada
  2. 2.McMaster UniversityHamiltonCanada
  3. 3.Abbott LaboratoriesMontrealCanada

Personalised recommendations