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

Abstract

Background and Aims Although many angiotensin receptor blockers (ARBs) are widely used, comparative data regarding their impact on clinical outcomes are limited. We aimed to compare the clinical effectiveness of seven ARBs on long‐term cardiovascular outcomes in Korean patients with hypertension. Methods Using the Korean National Health Insurance Service database, the data of 780,785 patients with hypertension without cardiovascular disease (CVD) who initiated ARB treatment (candesartan, fimasartan, irbesartan, losartan, olmesartan, telmisartan, or valsartan) in 2014 and underwent this treatment for more than 6 months, were analyzed. Cox‐regression analysis was performed using Losartan as a comparator, as it was the most widely used drug, by adjusting age, sex, diabetes, dyslipidemia, smoking, alcohol drinking, exercise, body mass index, systolic blood pressure, albuminuria, estimated glomerular filtration rate, and concomitant medications. The occurrence of mortality and the rate of major adverse cardiovascular events (MACEs) of the six ARBs was compared with that of losartan. Results The median follow‐up duration was 5.94 (interquartile range, 5.87–5.97) years. In the crude analysis of all‐cause mortality and MACEs, fimasartan exhibited the lowest event rates. In the Cox‐regression analysis with adjustment, there was no significant difference in all‐cause mortality among ARBs. The risk of MACEs with ARBs was similar to that with losartan, although the risks with irbesartan (hazard ratio [HR], 1.079; 95% confidence interval [CI], 1.033–1.127; p = 0.007) and candesartan (HR: 1.066; 95% CI, 1.028–1.106; p = 0.015) were slightly higher. Conclusion In a Korean population of patients with hypertension without CVD, six different ARBs showed similar efficacy to losartan in terms of long‐term mortality and MACEs. Further well‐designed prospective studies are required to confirm our findings.

Risk of myocardial infarction, heart failure, and cerebrovascular disease with the use of valsartan, losartan, irbesartan, and telmisartan in patients

“…[7] A recently published observational study has shown no difference in the risk of non-fatal MI and stroke among the use of 7 ARBs in patients with hypertension and without cardiovascular disease. [19] However, in our study, differences in the risks of MI and cerebrovascular disease among the use of ARBs were observed using telmisartan use as the reference standard. Valsartan and losartan use were associated with a higher risk of MI but a lower risk of cerebrovascular disease than telmisartan use.…”

Risk of myocardial infarction, heart failure, and cerebrovascular disease with the use of angiotensin receptor blockers: a retrospective cohort study

“…A previous meta-analysis of randomized clinical trials has shown no difference in the risk of MI and stroke among the use of the studied ARBs [7]. A recently published observational study has shown no difference in the risk of non-fatal MI and stroke among the use of seven ARBs in patients with hypertension and without cardiovascular disease [20]. However, in our study, differences in the risks of MI and cerebrovascular disease among the use of ARBs, using telmisartan use as the reference standard, were observed.…”

Efficacy and safety evaluation of Allisartan Isoproxil in patients with hypertension: a meta-analysis

“…The Renin-angiotensin-aldosterone system (RAAS) plays a crucial role in the pathogenesis of hypertension, prompting the latest guidelines to recommend angiotensin II receptor blockers (ARBs) as first-line therapy ( 21 , 22 ). By inhibiting Ang II binding to the angiotensin II type 1 receptor (AT1R), ARBs effectively mitigate vascular resistance, reduce blood pressure, and impede RAAS activation, thereby protecting target organs and preventing cardiovascular endpoint events ( 23 , 24 ).…”