Examining the Association of Olmesartan and Other Angiotensin Receptor Blockers With Overall and Cause-Specific Mortality

Abstract

Because these drugs are now widely used in large populations, it would seem appropriate to undertake a large-scale analysis to compare the mortality risks associated with each agent in patients with different clinical indications. WithinAbstract-Concerns about an increased cardiovascular risk with the angiotensin receptor blocker, olmesartan, prompted the current study to examine associations between olmesartan and other angiotensin receptor blockers with overall and causespecific mortalities. We collected patients who started to use losartan, valsartan, irbesartan, candesartan, telmisartan, and olmesartan between January 1, 2004, and December 31, 2009, from Taiwan's National Health Insurance claims database. Prescribed drug types, dosage, and other clinical information were collected. Overall mortality and causespecific mortality were ascertained through linkages with Taiwan's National Death Registry. Two follow-up analyses, labeled intention-to-treat and as-treated, were conducted. A Cox proportional hazard regression model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) using losartan as the reference group. A total of 690 463 subjects were included, with a mean follow-up ranging from a low of 2.8 years for olmesartan to a high of 4.1 years for irbesartan. Subjects who began with valsartan had a modest but significantly increased risk of overall mortality (HR, 1.04; 95% CI, 1.02-1.06) compared with losartan. Irbesartan (HR, 0.96; 95% CI, 0.94-0.99), candesartan (HR, 0.95; 95% CI, 0.92-0.99), telmisartan (HR, 0.93; 95% CI, 0.90-0.96), and olmesartan (HR, 0.93; 95% CI, 0.88-0.97) were associated with a slightly lower overall mortality risk than losartan. The analysis indicates that the differences in mortality risk among individual angiotensin receptor blockers were only marginal and thus less likely to be clinically important. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Department of Health, Execute Yuan, Taiwan.Correspondence to Chia-Hsuin Chang, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Rd, Section 1, Taipei, Taiwan. E-mail chiahsuin123@yahoo.com.tw Examining the Association of Olmesartan and Lin et al ARBs and Mortality 969the complex spectrum of cardiovascular disease, the potential differences among ARBs are unexplored largely in terms of arguably the most important clinical end point, mortality. Therefore, the study that follows was designed to use a nationwide retrospective cohort analysis to compare all-cause and cause-specific mortalities among patients treated with the most common ARBs including losartan, valsartan, irbesartan, candesartan, telmisartan, and olmesartan. Methods Data SourceA single-payer and compulsory National Health Insurance program was implemented in Taiwan in 1995, and enrollment was 99% by 2010. The Taiwan National Health Insurance database includes complete outpatient visits, hospital admissions, prescriptions, disease, and vital...

Long‐term mortality and cardiovascular events of seven angiotensin receptor blockers in hypertensive patients: Analysis of a national real‐world database: A retrospective cohort study

“…Moreover, the study population taking ARBs was relatively small ( n = 3490). A study in Taiwan that analyzed a large number of patients ( n = 690,463) from claims data compared the effects of six ARBs (candesartan, irbesartan, losartan, olmesartan, telmisartan, and valsartan) and found that olmesartan did not increase long‐term cardiovascular risk compared with that by losartan 28 . This study deserves attention in that it elucidates the effect of olmesartan, unlike previous studies.…”

“…A study in Taiwan that analyzed a large number of patients ( n = 690,463) from claims data compared the effects of six ARBs (candesartan, irbesartan, losartan, olmesartan, telmisartan, and valsartan) and found that olmesartan did not increase long‐term cardiovascular risk compared with that by losartan. 28 This study deserves attention in that it elucidates the effect of olmesartan, unlike previous studies. However, the study population was more heterogeneous as patients with underlying CVD were not excluded, contrary to the case in our study.…”

“…27 However, the primary goal of this study compared with that by losartan. 28 This study deserves attention in that it elucidates the effect of olmesartan, unlike previous studies.…”

Noninferiority studies with multiple reference treatments

“…28 In addition, there are concerns that olmesartan may increase cardiovascular risk. 29 To compare the new drug azilsartan to reference treatments, White et al 24 conducted an NI trial with two new treatments (azilsartan 40 mg and azilsartan 80 mg), two reference treatments (olmesartan 40 mg and valsartan 320 mg) and a placebo. The primary efficacy endpoint is the change from baseline in 24-h mean systolic blood pressure (BP).…”

Clinical Outcomes of Olmesartan/Rosuvastatin Combination Therapy in Acute Coronary Syndrome Patients With Essential Hypertension

“…18 Previous studies already have suggested that compared with other ARBs, olmesartan shows higher blood pressure-lowering effect, therefore, probably could contribute in reducing CVD risk. In addition, various meta-analyses have supported that olmesartan is not correlated with increased cardiovascular risk 19,20 and is currently used widely as antihypertensive medication.…”