Angiotensin receptor blockers may not reduce mortality in diabetes, hypertension settings

January 1, 2011

Antihypertensive therapy with an angiotensin receptor blocker 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.

Key Points

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. This data was reported at the 45th midyear meeting of the American Society of Health-System Pharmacists.

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=.8) and 0.7 mmHg in DBP (P=.3).

The incidence of cardiovascular mortality was 58.7% in the groups assigned to an ARB compared to 57.3% in the controls (P=.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Outcomes data from 2 unpublished trials of ARB-based therapy-ORIENT (Olmesartan Reducing Incidence of End Stage Renal Disease in Diabetic Nephropathy Trial) and ROADMAP (Randomized Olmesartan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.