ARB-based therapy does not reduce mortality in setting of diabetes and hypertension

Antihypertensive therapy with an angiotensin receptor blocker (ARB) is not associated with reductions in cardiovascular or all-cause mortality compared to non-ARB-based regimens in patients with type 2 diabetes, according to researchers at the Massachusetts College of Pharmacy and Health Sciences.

From a literature search, they identified 11 randomized, controlled trials in which an ARB was compared with placebo or an active control in type 2 diabetes with hypertension. Six studies reported blood pressure data and 6 reported all-cause mortality.

There were no significant differences between ARBs and controls in systolic blood pressure (SBP) or diastolic blood pressure (DBP), with a mean difference of 0.364 mmHg in SBP (P=0.8) and 0.7 mmHg in DBP (P=0.3).

All-cause mortality was not significantly different between the ARBs and controls (odds ratio of 0.968; P=0.878).

The incidence of cardiovascular mortality was 58.7% in the groups assigned to an ARB compared to 57.3% in the controls (P=0.84).

“ARBs should not be used as a first-line treatment in the treatment of hypertension in patients with type 2 diabetes until long-term follow-up can justify its benefit in cardiovascular outcomes,” the researchers said. “ARB-based blood pressure reduction strategies can be reserved for second- and third-line use or as part of combination therapy.”

Outcomes data from 2 unpublished trials of ARB-based therapy-ORIENT (Olmesartan Reducing Incidence of End Stage Renal Disease in Diabetic Nephropathy Trial) and ROADMAP (Randomized Olmesartan and Diabetes Microalbuminuria Prevention Study) will provide clarity, they said.