Comparing angiotensin II receptor blockers on benefits beyond blood pressure

Siragy, Helmy M.

doi:10.1007/s12325-010-0028-3

Cited by 17 publications

(19 citation statements)

References 122 publications

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“…As noted by Sipahi and colleagues, publication bias was also a significant limiting factor in this meta-analysis. There is a lack of published and/or publicly available information on the incidence of cancer observed in clinical trials of ARBs 20. Specifically, many large trials (eg, VALUE,29 Study on Cognition and Prognosis in the Elderly [SCOPE]55) did not collect cancer data or did not provide their cancer data to the authors of this study; of 60 trials identified as meeting the inclusion criteria for this analysis, data on cancer incidence and/or cancer deaths were only available from nine trials 13.…”

Section: Safety Of Arbs and The Dri Aliskirenmentioning

confidence: 99%

A current evaluation of the safety of angiotensin receptor blockers and direct renin inhibitors

Siragy¹

2011

VHRM

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The safety of angiotensin II receptor blockers (ARBs) for the treatment of hypertension and cardiovascular and renal diseases has been well documented in numerous randomized clinical trials involving thousands of patients. However, recent concerns have surfaced about possible links between ARBs and increased risks of myocardial infarction and cancer. Less is known about the safety of the direct renin inhibitor aliskiren, which was approved as an antihypertensive in 2007. This article provides a detailed review of the safety of ARBs and aliskiren, with an emphasis on the risks of cancer and myocardial infarction associated with ARBs. Safety data were identified by searching PubMed and Food and Drug Administration (FDA) Web sites through April 2011. ARBs are generally well tolerated, with no known class-specific adverse events. The possibility of an increased risk of myocardial infarction associated with ARBs was suggested predominantly because the Valsartan Antihypertensive Long-Term Use Evaluation (VALUE) trial reported a statistically significant increase in the incidence of myocardial infarction with valsartan compared with amlodipine. However, no large-scale, randomized clinical trials published after the VALUE study have shown a statistically significant increase in the incidence of myocardial infarction associated with ARBs compared with placebo or non-ARBs. Meta-analyses examining the risk of cancer associated with ARBs have produced conflicting results, most likely due to the inherent limitations of analyzing heterogeneous data and a lack of published cancer data. An ongoing safety investigation by the FDA has not concluded that ARBs increase the risk of cancer. Pooled safety results from clinical trials indicate that aliskiren is well tolerated, with a safety profile similar to that of placebo. ARBs and aliskiren are well tolerated in patients with hypertension and certain cardiovascular and renal conditions; their benefits outweigh possible safety concerns.

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Section: Safety Of Arbs and The Dri Aliskirenmentioning

confidence: 99%

A current evaluation of the safety of angiotensin receptor blockers and direct renin inhibitors

Siragy¹

2011

VHRM

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“…Another reason may be that regardless of the presence of MetS, ACEI/ARB may not be protective against the risk of cerebrovascular events, as was previously reported [36]. Sub-analysis by race in the LIFE study, for example, showed that African-American participants treated with losartan were actually at higher risk for stroke events than African-American individuals who received atenolol [36]. The analysis of several double-blinded randomized controlled trials have also suggested that the use of ACEI might not be protective against stroke and may be associated with greater risk for stroke [37].…”

Section: Discussionmentioning

confidence: 94%

“…This may explain the lack of effect in our study consisting only of individuals with MetS based on the ATP-III definition. Another reason may be that regardless of the presence of MetS, ACEI/ARB may not be protective against the risk of cerebrovascular events, as was previously reported [36]. Sub-analysis by race in the LIFE study, for example, showed that African-American participants treated with losartan were actually at higher risk for stroke events than African-American individuals who received atenolol [36].…”

Section: Discussionmentioning

confidence: 97%

Effect of Renin–Angiotensin System Inhibition on Cardiovascular Events in Older Hypertensive Patients with Metabolic Syndrome

et al. 2014

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Objective Metabolic syndrome (MetS) is associated with cardiovascular disease (CVD). Insulin resistance has been hypothesized as the underlying feature of MetS. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are widely used antihypertensives that may improve insulin sensitivity. The aim of the study is to evaluate the effect of ACEI/ARB on incident CVD events in older hypertensive patients with MetS. Materials/Methods We used the Cardiovascular Health Study, a prospective cohort study of individuals > 65 years of age to evaluate ACEI/ARB use and time to CVD events (including coronary and cerebrovascular events). The study included 777 subjects who had hypertension and ATP III-defined MetS, but free of CVD and diabetes at baseline. Cox regression models were used to evaluate the effect of ACEI/ARB as compared to other antihypertensives on the time to the first CVD events. Results ACEI/ARB use was associated with a decreased risk of CVD events (adjusted HR=0.658, 95 % C.I. [0.436-0.993]) compared to other antihypertensives. When CVD endpoints were evaluated separately, use of ACEI/ARB was associated with lower rates of angioplasty and coronary events (HR of 0.129 and 0.530 respectively, with 95 % CI [0.017-0.952] and [0.321-0.875]). Conclusions ACEI/ARB use was associated with a lower risk of CVD events in older hypertensive patients with MetS, primarily due to a reduction in coronary events. The potential protective effect of ACEI/ARB on CVD events in older individuals with MetS will need further confirmation from prospective studies.

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“…[9] Metabolic syndrome (MetS) increases the risk for T2DM and CVD[10–17] and affects over one-third of US adults[18]. Imbalances in these biomarkers are thought to mediate comorbidities of obesity, and pharmacologic alterations of selected ATGMCVR have already been shown to provide substantial cardiovascular health benefits[19, 20]. At present, the primary management of MetS or any of the criterion for MetS involves healthy lifestyle promotion through weight management, dietary energy restriction and increased physical activity.…”

Section: Introductionmentioning

confidence: 99%

Effects of a community-based weight loss intervention on adipose tissue circulating factors

Miller

Isom

Morgan

et al. 2014

Diabetes & Metabolic Syndrome: Clinical Research & Revi

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Background/Objectives Obesity is associated with metabolic dysfunctions, which may be mediated by changes in adipose tissue signaling factors. These molecules are denoted as Adipose Tissue Generated Mediators of CardioVascular Risk (ATGMCVR) here, and include leptin, adiponectin, C-reactive protein (CRP), interleukin 6 (IL-6), tumor necrosis factor alpha (TNFα), and plasminogen activator inhibitor 1 (PAI-1). This study examined the effect of a weight loss program on ATGMCVR in obese adults with prediabetes. Subjects/Methods Subjects were randomized to usual care (UC; n=15) or lifestyle weight loss groups (LWL; n=15). LWL was a community-based weight loss intervention to promote physical activity and healthy eating. ATGMCVR at 1-yr were compared between groups by analysis of covariance; baseline value of the mediator was the covariate. Baseline means for ATGMCVR were compared between those with (n=21) and without (n=9) metabolic syndrome (MetS). Results At baseline, subjects were 58±9 (SD) yrs, 70% female, with a BMI of 34±4 kg/m2. One-yr weight loss (%) was 7.8±6.0% for LWL and 1.7±4.5% for UC. Group differences at 1-yr were noted (adjusted means [95%CI] for UC and LWL, respectively) for adiponectin (8526.3 [7397.7,9827]; 10870.9 [9432.0,12529.3] ng/ml; p=0.02), leptin (30.4 [26.1,35.4]; 23.7 [20.3,27.5] ng/ml; p=0.02), IL-6 (0.4 [0.3,0.5]; 0.2 [0.1,0.2] pg/ml; p=0.001), and PAI-1 (50 [42.7,58.7]; 36.2 [30.8,42.4] pg/ml; p=0.01). No differences in baseline ATGMCVR were seen between subjects with and without MetS. Conclusions These findings suggest ATGMCVR can be improved with weight loss; larger studies are needed to determine if improvements in metabolic dysfunction are related to changes in ATGMCVR.

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Comparing angiotensin II receptor blockers on benefits beyond blood pressure

Cited by 17 publications

References 122 publications

A current evaluation of the safety of angiotensin receptor blockers and direct renin inhibitors

A current evaluation of the safety of angiotensin receptor blockers and direct renin inhibitors

Effect of Renin–Angiotensin System Inhibition on Cardiovascular Events in Older Hypertensive Patients with Metabolic Syndrome

Effects of a community-based weight loss intervention on adipose tissue circulating factors

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