Key result
Valsartan linked to ~30% lower risk of major cardiovascular or renal events vs metoprolol ER.
Why the study?
Comparative effectiveness of valsartan versus lisinopril or extended-release metoprolol in preventing cardiovascular and renal events in hypertensive patients was not well established.
Does valsartan reduce major cardiovascular or renal events compared to lisinopril or extended-release metoprolol in patients with hypertension?
Observational (n=29,357)
Yes
Does valsartan reduce major cardiovascular or renal events compared to lisinopril or extended-release metoprolol in patients with hypertension?
In a retrospective cohort of hypertensive patients without prior major cardiovascular or renal events, initiating valsartan was associated with a lower risk of composite cardiovascular and renal events compared to extended-release metoprolol, but was not significantly different from lisinopril.
Answers are grounded in this paper and cite their sources.
Valsartan was associated with lower major event risk versus metoprolol but not lisinopril; leaves open need for prospective trials before changing hypertension therapy.
PURPOSE: The objective of this study was to compare cardiovascular and renal events in patients with hypertension receiving the angiotensin II-receptor blocker valsartan versus those receiving the angiotensin-converting-enzyme lisinopril or the beta-blocker metoprolol succinate in an extended-release formulation. METHODS: A retrospective study was conducted using a health insurance claims database spanning the period from January 1997 through December 2003 and representing approximately 40 million members enrolled in over 70 health plans across the United States. Study subjects included all persons in the database with two or more outpatient prescriptions for valsartan, lisinopril, or extended-release metoprolol and two or more prior claims with a diagnosis of hypertension. Those with a history of major cardiovascular or renal events (diagnosis of myocardial infarction, stroke, heart failure, ventricular arrhythmias, or cardiac arrest; coronary revascularization procedure; diagnosis of renal failure; or dialysis or kidney transplantation) or using other antihypertensive medications except diuretics during the 12 months before treatment with valsartan, lisinopril, or extended-release metoprolol were excluded. Risks of major cardiovascular or renal event during follow-up were analyzed using Cox proportional hazards regression. RESULTS: A total of 29,357 antihypertensive patients were identified who initiated therapy with valsartan (n = 6,645), lisinopril (n = 17,320), or extended-release metoprolol (n = 5,392). In multivariate analyses, therapy with valsartan was associated with a significantly lower risk of a major cardiovascular or renal event versus extended-release metoprolol (heart rate [HR], 0.70; 95% confidence interval [CI], 0.56-0.87; p = 0.0015). Patients receiving valsartan had a nominally lower risk of a major cardiovascular or renal event than those receiving lisinopril, although this difference was not statistically significant (HR, 0.89; 95% CI, 0.74-1.07; p = 0.1987). CONCLUSION: Results of this observational study suggest that the use of valsartan may reduce the risk of major cardiovascular and renal events compared with extended-release metoprolol.
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Delea et al. (2007) conducted an observational in Hypertension (n=29,357). Valsartan vs. Lisinopril or extended-release metoprolol was evaluated on Major cardiovascular or renal event (HR 0.70, 95% CI 0.56-0.87, p=0.0015). Valsartan was associated with a significantly lower risk of major cardiovascular or renal events compared with extended-release metoprolol (HR 0.70; 95% CI 0.56-0.87; p=0.0015).
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