Newer Blood Pressure Drug Better for Some Heart Patients, Diabetics

SUNDAY Aug. 31, 2008 -- A new study offers a possible alternative to heart patients and diabetics who need to keep their blood pressure under control but who cannot tolerate the standard treatment of ACE inhibitors.

Reporting at the European Society of Cardiology in Munich on Sunday, Canadian researchers said they found that the angiogenesis-receptor blocker (ARB) known as telmisartan worked well for the 20 percent of patients with vascular disease and high-risk diabetes who can't take ACE inhibitors. The study was released in the Aug. 31 online issue of The Lancet to coincide with the meeting presentation.

In the randomized, controlled trial, almost 6,000 patients with vascular disease or high-risk diabetes took either telmisartan or a placebo, and were followed for almost five years. Rates of death, heart attack, stroke or hospitalization for heart failure were tracked as primary outcome measures during the study period.

Mean blood pressure was lower in the telmisartan group by 4.0/2.2 mm/Hg, and there was a relative risk reduction of 13.3 percent for those taking telmisartan. Fewer patients on the medication wound up in the hospital for cardiovascular problems (30.3 percent), compared to those on placebo (33 percent).

"These data suggest that telmisartan confers a modest benefit when added to other proven therapies," the researchers wrote in a news release from the journal. "In view of the drug's tolerability and effect on cardiovascular endpoints, telmisartan could be regarded as a potential treatment for patients with vascular disease or high-risk diabetes, if they are unable to tolerate an ACE inhibitor."

However, an accompanying commentary from U.S. experts dampened the significance of the finding.

"ARBs that have been studied in coronary disease are safe, but possibly less effective alternatives in patients with intolerance to ACE inhibitors. Although data are too limited to reach definitive conclusions, the clinical effect of ARBs seems less robust than that of ACE inhibitors," wrote Dr. Toni Ripley and Dr. Donald Harrison, from the University of Oklahoma College of Pharmacy.

And U.S. researchers reported on Wednesday that telmisartan does not lower the rate of stroke, cardiovascular events or diabetes better than a placebo in patients who have had a stroke.

More information

For more on ARBs, go to U.S. Food and Drug Administration.

Posted: August 2008


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