College of Cardiology 60th Annual Scientific Sessions
NEW ORLEANS — Valsartan, an angiotensin II receptor
blocker, and amlodipine, a calcium channel blocker, comparably reduced adverse
cardiovascular events in hypertensive patients with diabetes or glucose
intolerance, according to data presented here.
“Many hypertension treatment guidelines recommend
angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers
(ARBs) as first-line treatment for hypertensive patients with diabetes,
especially for prevention of major CV events,” Toyoaki Murohara, MD,
PhD, lead researcher of the NAGOYA HEART Study, said during a press
conference. “But some clinical trials show that calcium channel blockers
(CCBs) are almost equally effective in reducing the risk of CV disease as
compared to ARBs.”
The NAGOYA HEART Study is the first randomized trial
comparing the efficacy of an ARB with a CCB, according to Murohara. For the
trial, Murohara and colleagues recruited 1,150 hypertensive patients with
diabetes or glucose intolerance at 46 facilities in Japan. Between October 2004
and July 2010, the researchers randomly assigned patients to receive valsartan
(Diovan, Novartis) or amlodipine (Norvasc, Pfizer) as first-line treatment. The
study’s primary outcome measure was a composite of CV events, including
acute myocardial infarction, stroke, coronary revascularization, hospital
admission resulting from congestive heart failure (CHF) and sudden cardiac
death. Blood pressure and HbA1c levels were also monitored.
Follow-up lasted a median of 3.2 years, with analysis
occurring every month for the first 3 months and then every 1 to 3 months
thereafter. Results revealed that 54 patients (9.4%) assigned to valsartan and
56 (9.7%) assigned to amlodipine experienced the primary outcome (HR=0.97; 95%
CI, 0.66-1.4), suggesting no significant differences between treatment groups.
Analysis of individual components of the primary outcome, however, indicated
that the incidence of hospital admission for CHF was higher in the amlodipine
group, with the event occurring in three patients (0.5%) in the valsartan arm
vs. 15 patients (2.6%) in the amlodipine arm (HR=0.2; 95% CI, 0.06-0.69).
BP and HbA1c levels also appeared similar between the
groups, the researchers said. At 54 months, BP decreased to 131/73 mm Hg in the
valsartan group and 132/74 mm Hg in the amlodipine group. HbA1c levels were
lowered to 6.7% in both groups.
“Our present paper shows that ARB is superior to
CCB in HF, and clinical trends already show ACE inhibitors slow [the
development of] some of the complications of diabetes,” Murohara
said. “Our study results support the current guidelines recommending ARB
and ACE inhibitors for first-line treatment in diabetic patients with
hypertension.” - by Melissa Foster
Disclosure: Dr. Murohara receives lecturer’s fees from
Daiichi-Sankyo, Novartis, Pfizer and Takeda (Modest). In the past 5 years, he
has also received research grants from Astellas, AstraZeneca, Bayer, Boehringer
Ingelheim, Daiichi Sankyo, Eisai, Kowa, Kyowa Hakko Kirin, MSD, Novartis,
Pfizer, Sanofi Aventis, Schering-Plough and Takeda.
For more information:
- Murohara T. LBCT IV 3015. Presented at: ACC 60th Annual Scientific
Sessions; April 2-5, 2011; New Orleans.