July 16, 2013
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Telmisartan, valsartan linked to lower risk for CV events in diabetes

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Telmisartan and valsartan were associated with a lower risk for hospital admission due to acute MI, stroke or HF compared with other angiotensin receptor blockers, according to new data.

Researchers conducted a population-based, retrospective cohort study of 54,186 patients aged at least 66 years with diabetes who initiated treatment with candesartan (Atacand, AstraZeneca), irbesartan (Avapro, Sanofi-Aventis), losartan (Cozaar, Merck), telmisartan (Micardis, Boehringer Ingelheim) or valsartan (Diovan, Novartis) from 2001 to 2011. A composite of hospitalization for MI, HF or stroke served as the primary endpoint.

“We speculated that, owing to its pleiotropic effects, telmisartan would be associated with a lower risk of macrovascular events in these patients relative to other angiotensin receptor blockers,” researchers wrote.

Patients treated with telmisartan (adjusted HR=0.85; 95% CI, 0.74-0.97) or valsartan (HR=0.86; 95% CI, 0.77-0.95) had a lower risk for the composite outcome compared with those treated with irbesartan, after multivariable adjustment. However, the researchers observed no significant difference in risk between irbesartan and other angiotensin receptor blockers.

Results from secondary analyses linked telmisartan (adjusted HR=0.79; 95% CI, 0.66-0.96) with lower risk for hospital admission for HF, as compared with irbesartan. There were no significant differences in risk between angiotensin receptor blockers in all other comparisons, according to the researchers.

“Although angiotensin receptor blockers share common structural features, important pharmacologic differences exist between the drugs that may explain our results,” the researchers wrote.

“Pending confirmatory data from additional observational studies or randomized controlled trials, we suggest that a class effect may not be assumed when using angiotensin receptor blockers for the prevention of diabetes-related macrovascular complications or heart failure, and that telmisartan and valsartan may be the preferred drugs for this indication.”

Disclosure: See the study for a full list of financial disclosures.