Key result
ARBs lack conclusive evidence for reducing CV events in essential hypertension without compelling indications.
Why the study?
Do angiotensin receptor blockers (ARBs) reduce cardiovascular events in patients with essential hypertension without compelling indications?
Do angiotensin receptor blockers (ARBs) reduce cardiovascular events in patients with essential hypertension without compelling indications?
Evidence supporting the routine use of ARBs as first-line therapy for reducing cardiovascular events in patients with essential hypertension without compelling indications is limited and inconclusive.
Evidence for ARBs in uncomplicated hypertension remains limited and inconclusive; leaves open first-line recommendation pending further trials.
OBJECTIVE: To review the role of angiotensin receptor blockers (ARBs) for the prevention of cardiovascular events in patients with essential hypertension without other compelling indications. DATA SOURCES: Peer-reviewed clinical trials, review articles, and relevant treatment guidelines were identified from MEDLINE and Current Content database (both 1966-November 15, 2012) using the search terms angiotensin receptor blockers (ARBs), azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan, hypertension, myocardial infarction, stroke, heart failure, and cardiovascular outcomes. Results were limited to human trials published in English. Citations from articles were also reviewed for additional references. STUDY SELECTION AND DATA EXTRACTION: The focus was on clinical trials evaluating cardiovascular end points of ARBs used in patients with essential hypertension without compelling indications. DATA SYNTHESIS: Data supporting the use of ARBs for reducing cardiovascular events in patients with essential hypertension without compelling indications are inconsistent. To date, only candesartan and losartan have shown a significant reduction in cardiovascular morbidity within this sizable subgroup of patients. In the Study on Cognition and Prognosis in the Elderly (SCOPE) trial, candesartan showed a 27.8% reduction in nonfatal stroke versus placebo (95% CI 1.3-47.2; p = 0.04). Moreover, losartan demonstrated a decrease in all cardiovascular events compared to atenolol in the Cardiovascular Morbidity and Mortality in the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study (RR 0.87; 95% CI 0.77-0.98; p = 0.021). CONCLUSIONS: Data supporting the use of ARBs for reducing cardiovascular events in patients with essential hypertension without compelling indications are limited and inconclusive. More studies are needed before ARBs can be routinely recommended as first-line therapy for hypertension management in patients without other compelling indications.
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Zaiken et al. (2013) conducted a review in Essential hypertension without compelling indications. Angiotensin receptor blockers (ARBs) was evaluated on Cardiovascular events. Data supporting the use of ARBs for reducing cardiovascular events in patients with essential hypertension without compelling indications are limited and inconclusive.
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