Key result
Compared with telmisartan, valsartan and losartan were associated with a higher risk of myocardial infarction (HR 1.39 and 1.10) but a lower risk of cerebrovascular disease, while irbesartan was associated with a lower risk of myocardial infarction (HR 0.90) but a higher risk of cerebrovascular disease.
Why the study?
There is a lack of studies comparing the risk of cardio-cerebrovascular disease between angiotensin receptor blockers of different half-lives.
Do different ARBs (valsartan, losartan, irbesartan) compared to telmisartan alter the risk of myocardial infarction, heart failure, and cerebrovascular disease in patients aged ≥ 40 years with hypertension?
Cohort (n=592,916)
Do different ARBs (valsartan, losartan, irbesartan) compared to telmisartan alter the risk of myocardial infarction, heart failure, and cerebrovascular disease in patients aged ≥ 40 years with hypertension?
Hazard Ratio: 1.39 (95% CI 1.33–1.45)
Absolute Event Rate: 41.99% vs 28.8%
Different ARBs exhibit varying risks for myocardial infarction and cerebrovascular disease, suggesting that half-life may influence specific cardiovascular outcomes in hypertensive patients.
Background:There is a lack of studies comparing the risk of cardio-cerebrovascular disease between angiotensin receptor blockers (ARBs) of different half-lives.Aim:To compare the risks of myocardial infarction, heart failure, and cerebrovascular disease with the use of ARBs with different half-lives in a retrospective cohort of patients aged ≥ 40 years with hypertension.Method:We performed propensity score matching to establish a cohort of 148,229 patients exposed to valsartan, losartan, irbesartan, or telmisartan. We used an as-treated approach to evaluate exposure and the Cox regression logistic model to calculate the incidence rates and adjusted hazard ratios (aHRs, 95% confidence interval) for MI, heart failure, and cerebrovascular disease with valsartan, losartan, and irbesartan compared to telmisartan.Results:The matched cohort analysis showed that the risk of myocardial infarction was higher for valsartan use (1.39, 1.33–1.45) and losartan use (1.10, 1.05–1.15) but lower for irbesartan use (0.90, 0.86-0.94) than telmisartan use. Compared with telmisartan use, the risk for cerebrovascular disease was lower for valsartan use (0.85, 0.83–0.87) and losartan use (0.80, 0.78–0.82) but higher for irbesartan use (1.11, 1.09–1.13).Conclusion:We found differences in the risk of myocardial infarction and cerebrovascular disease with the use of ARBs with different half-lives. Valsartan and losartan with a short half-life, which showed a higher risk of myocardial infarction, had a lower risk of cerebrovascular disease. Conversely, irbesartan with a long half-life, which showed a lower risk of myocardial infarction, had a higher risk of cerebrovascular disease.
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Yoo et al. (2023) conducted a cohort in Hypertension (n=592,916). Valsartan vs. Telmisartan was evaluated on Myocardial infarction (HR 1.39, 95% CI 1.33-1.45). Compared with telmisartan, valsartan and losartan were associated with a higher risk of myocardial infarction (HR 1.39 and 1.10) but a lower risk of cerebrovascular disease, while irbesartan was associated with a lower risk of myocardial infarction (HR 0.90) but a higher risk of cerebrovascular disease.
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