ARB-based therapy does not reduce mortality in setting of diabetes and hypertension
Antihypertensive therapy with an angiotensin receptor blocker (ARB) is not associated with reductions in cardiovascular or all-cause mortality compared to non-ARB-based regimens in patients with type 2 diabetes, according to researchers at the Massachusetts College of Pharmacy and Health Sciences.
From a literature search, they identified 11 randomized, controlled trials in which an ARB was compared with placebo or an active control in type 2 diabetes with hypertension. Six studies reported blood pressure data and 6 reported all-cause mortality.
There were no significant differences between ARBs and controls in systolic blood pressure (SBP) or diastolic blood pressure (DBP), with a mean difference of 0.364 mmHg in SBP (P=0.8) and 0.7 mmHg in DBP (P=0.3).
All-cause mortality was not significantly different between the ARBs and controls (odds ratio of 0.968; P=0.878).
The incidence of cardiovascular mortality was 58.7% in the groups assigned to an ARB compared to 57.3% in the controls (P=0.84).
“ARBs should not be used as a first-line treatment in the treatment of hypertension in patients with type 2 diabetes until long-term follow-up can justify its benefit in cardiovascular outcomes,” the researchers said. “ARB-based blood pressure reduction strategies can be reserved for second- and third-line use or as part of combination therapy.”
Outcomes data from 2 unpublished trials of ARB-based therapy—ORIENT (Olmesartan Reducing Incidence of End Stage Renal Disease in Diabetic Nephropathy Trial) and ROADMAP (Randomized Olmesartan and Diabetes Microalbuminuria Prevention Study) will provide clarity, they said.
MORE ARTICLES IN THIS ISSUE
A higher prescription co-payment, especially among older women, is associated with the early discontinuation and incomplete use of adjuvant aromatase inhibitor therapy, a life-saving therapy for women with hormone-sensitive, early-stage breast cancer, research shows.
FDA announced recently that the injection form of Anzemet (dolasetron mesylate) should no longer be used to prevent chemotherapy-induced nausea and vomiting.
Patients who switch statins have lower persistence to therapy compared to those who don?t switch, according to a poster recently presented at the 45th midyear meeting of the American Society of Health-Systems Pharmacists.