July 17, 2013
Study Says Two ARBs Are Best for Patients With Diabetes

Toronto—A new study suggests that telmisartan and valsartan are the preferred ARBs (angiotensin-receptor blockers) to reduce blood pressure in patients with diabetes.

The two drugs were found to be most effective in lowering risk of hospitalization for heart attack, stroke, or heart failure in those patients, according to the report published in the Canadian Medical Association Journal.

The authors note that ARBs, including telmisartan, valsartan, candesartan, irbesartan, and losartan, are generally used interchangeably to control blood pressure, despite evidence from small trials that telmisartan demonstrates slightly different properties and could have a beneficial effect on cardiovascular health.

For the study, researchers looked at data for 54,186 Ontario residents with diabetes—all over 65—taking ARBs between April 1, 2001 and March 31, 2010. Seeking to determine if patients prescribed telmisartan had lower risk of cardiovascular illnesses than those prescribed other drugs in the same class, they actually determined that both telmisartan and valsartan lowered cardiovascular comorbidity risks.

“Our findings suggest that statistically important differences exist in the effectiveness of angiotensin-receptor blockers when used for the prevention of diabetes-related macrovascular disease, and that a class effect for these agents may not be assumed when used for this purpose in clinical practice,” write the authors, led by Tony Antoniou, PharmD, of St. Michael's Hospital in Toronto.

“Although angiotensin-receptor blockers share common structural features, important pharmacologic differences exist between the drugs that may explain our results,” the report states. “Specifically, at clinically attainable serum concentrations, telmisartan is unique among these drugs in its ability to structurally interact with and activate the PPARg receptor, a ligand-activated transcription factor that regulates lipid metabolism and insulin sensitivity.”

Study authors call for randomized, controlled trials and larger observational studies to look at which ARBs are most effective in patients with diabetes.

Based on this study’s results, however, “Telmisartan and valsartan may therefore
be the preferred angiotensin-receptor blockers for use in these patients,” they recommend.

U.S. Pharmacist Social Connect