A new study has found that certain angiotensin-receptor blockers (ARBs) offer better protection against macrovascular disease for patients with diabetes.
ARBs are a group of medications that are widely used to treat high blood pressure (hypertension) and heart failure, and prevent kidney failure in people with diabetes (diabetic nephropathy).
Small studies in the past have linked the use of the ARB telmisartan with greater improvements in surrogate markers of cardiovascular health in diabetic patients, compared to other drugs in this class.
To explore whether this translates into a reduced risk of cardiovascular events and death, researchers in Toronto, Canada, conducted a large study of 54,186 patients with diabetes, aged 66 years or older, who started treatment with an ARB – candesartan (20.2%), irbesartan (23.4%), losartan (15.5%), telmisartan (15.1%) or valsartan (25.8%) – between 2001 and 2011.
After adjusting for multiple confounding variables, the team found patients treated with telmisartan were 15 less likely to be admitted to hospital for acute myocardial infarction (MI), stroke or heart failure than patients taking irbesartan.
Valsartan was also associated with a similar (14%) reduction in the risk of these cardiovascular complications, compared with irbesartan. However, there was no difference in risk between irbesartan and either losartan or candesartan among the diabetic patients.
“Pending confirmatory data from additional observational studies or randomised controlled trials, we suggest that a class effect may not be assumed when using angiotensin-receptor blockers for the prevention of diabetes-related macrovascular disease,” the researchers concluded, adding that “telmisartan and valsartan may be the preferred drugs for this purpose.”
The findings were published online July 8 in the Canadian Medical Association Journal (CMAJ).

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