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September 5, 2026Hypertension Research

Long-term outcomes associated with continued use of ARBs versus CCBs in older adults: a landmark cohort study

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Why the study?

Evidence guiding treatment selection for patients already receiving long-term antihypertensive therapy remains uncertain, particularly in older adults.

Does continued use of ARBs reduce adverse cardiovascular and renal outcomes compared to CCBs in older adults on sustained antihypertensive therapy?

Population

59,558 individuals aged ≥65 years receiving sustained antihypertensive therapy in Japan

Comparison

Continued ARBs vs continued CCBs

Design

Retrospective landmark cohort study

Follow-up

Median 4.75 years

Key result

In a 24-month landmark sensitivity analysis, continued use of ARBs was associated with a lower 5-year risk of heart failure hospitalization compared to CCBs (HR 0.885, 95% CI 0.835-0.939).

Authors

HNHisashi NomaHSHiroshi SunadaHYHajime Yamazaki

Discussion

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Member takes

Overview

May guide ARB vs CCB selection in older adults on long-term therapy; leaves open need for RCTs to confirm outcomes.

Key Points

  • To compare long-term clinical outcomes between older adults who continue receiving angiotensin receptor blockers (ARBs) versus calcium channel blockers (CCBs) during sustained antihypertensive therapy.
  • Conducted a retrospective landmark cohort study using linked administrative claims and health examination data from Japan among 59,558 individuals aged ≥65 years (20,028 ARB users and 39,530 CCB users) with ≥12 months of continuous therapy.
  • Tracked participants over a median follow-up of 4.75 years using discrete-time proportional hazards models with inverse probability of treatment and censoring weighting.
  • Sustained ARB use was associated with a significantly lower risk of heart failure hospitalization (HR 0.817, 95% CI 0.758–0.882) and end-stage renal disease (HR 0.162, 95% CI 0.089–0.295) compared to CCB use.
  • Risks of myocardial infarction, major adverse cardiovascular events, and stroke did not differ meaningfully between groups, and blood pressure levels remained comparable throughout follow-up.

Study Design

Type

Cohort (n=59,558)

Multicenter

Yes

Structured PICO

Does continued use of ARBs reduce adverse cardiovascular and renal outcomes compared to CCBs in older adults on sustained antihypertensive therapy?

P
Population
59,558 older adults (mean age 74.9 years, 55.6% female) in Japan with sustained use of ARBs or CCBs, evaluated for long-term cardiovascular and renal outcomes.
E
Exposure
Continued use of angiotensin receptor blockers (ARBs)
C
Comparator
Continued use of calcium channel blockers (CCBs)
O
Outcome
Heart failure hospitalization and end-stage renal disease (ESRD)hard clinical

In older adults on long-term antihypertensive therapy, continued ARB use is associated with lower risks of heart failure hospitalization and ESRD compared to CCBs, despite similar blood pressure control.

Limitations

  • Main study results are not included in this supplemental document
  • Loss to follow-up and treatment changes during the study period
  • Missing baseline data requiring multiple imputation

Cite This Study

Noma et al. (2026) conducted a cohort in Hypertension (n=59,558). Angiotensin receptor blockers (ARBs) vs. Calcium channel blockers (CCBs) was evaluated. In a 24-month landmark sensitivity analysis, continued use of ARBs was associated with a lower 5-year risk of heart failure hospitalization compared to CCBs (HR 0.885, 95% CI 0.835-0.939).

synapsesocial.com/papers/6a9c012d6b95aff0620ec811https://doi.org/10.1038/s41440-026-02793-4
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