VALUE was a randomized, double-blind,
prospective, multicenter, active-controlled,
parallel-group trial comparing the longterm cardioprotective eﬀects of regimens
based on the angiotensin-receptor blocker
valsartan or the calcium antagonist amlodipine, in patients with previously treated
or untreated essential hypertension and
Blood pressure was reduced to normal levels in both treatment arms. The eﬀect was
initially more pronounced in patients on amlodipine. The between-arm diﬀerence was
4.0/2.1 mm Hg at 1 month, but decreased
to, and stabilized at, 1.5/1.3 mm Hg after
high cardiovascular risk. 
12 months (p<0.001).
A total of 15,245 patients aged 50 years or
Table 1 shows the major ﬁndings of the
older with similar demographics, hypertension severity, cardiovascular risk, and hypertensive therapy used before the study
were randomized to once-daily valsartan
80 mg or amlodipine 5 mg. Five step upward titration was performed at one-month
intervals to achieve a blood pressure below 140/90 mm Hg.
Patients were followed up for a mean of
4.2 years with regular visits. The primary
endpoint was a composite of cardiac morbidity and mortality. Secondary endpoints
were time to ﬁrst myocardial infarction,
heart failure, stroke, all-cause deaths and
new-onset type 2 diabetes.
No signiﬁcant diﬀerence in the primary
composite endpoint of cardiac morbidity
and mortality was found between
valsartan-based and amlodipine-based
regimens (10.6% vs. 10.4%, p=0.49).
As for the secondary endpoints, more
strokes and myocardial infarctions were reported for patients on valsartan than for
those on amlodipine (4.2% vs. 3.7%,
p=0.08; 4.8% vs. 4.1%, p=0.02). However,
this disparity was most apparent in the
early period of the study–when blood pressure diﬀerences between the two treatment arms were more pronounced–and decreased thereafter.