Recently, we reported that angiotensin II receptor blocker (ARB), valsartan, and calcium
channel blocker (CCB), amlodipine, had similar effects on the prevention of cardiovascular
disease (CVD) events in diabetic hypertensive patients. We assessed the difference
of cardiovascular protective effects between ARB and CCB in patients with and without
previous CVD, respectively. A total of 1,150 Japanese diabetic hypertensive patients
were randomized to either valsartan or amlodipine treatment arms, which were additionally
divided into 2 groups according to the presence of previous CVD at baseline (without
CVD, n = 818; with CVD, n = 332). The primary composite outcomes were sudden cardiac
death, acute myocardial infarction, stroke, coronary revascularization, or hospitalization
for heart failure. The incidence of primary end point events in patients with previous
CVD was 3.5-times greater than that in patients without previous CVD (64.1 vs 17.9/1,000
person-years). The ARB- and the CCB-based treatment arms showed similar incidence
of composite CVD events in both patients without previous CVD (hazard ratio [HR] 1.35,
95% confidence interval [CI] 0.76 to 2.40) and those with previous CVD (HR 0.79, 95%
CI 0.48 to 1.31). The ARB-treatment arm showed less incidence of stroke compared with
the CCB-based treatment arm in patients with previous CVD (HR 0.24, 95% CI 0.05 to
1.11, p = 0.068), whereas the 2 treatment arms showed similar incidence of stroke
in patients without previous CVD (HR 1.52, 95% CI 0.59 to 3.91). In conclusion, the
ARB- and the CCB-based treatments exerted similar protective effects of CVD events
regardless of the presence of previous CVD. For stroke events, the ARB may have more
protective effects than the CCB in diabetic hypertensive patients with previous CVD.
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Article info
Publication history
Published online: September 16, 2013
Accepted:
July 26,
2013
Received in revised form:
July 26,
2013
Received:
April 10,
2013
Footnotes
The NAGOYA HEART Study is registered at http://clinicaltrials.gov/ct2/show/NCT00129233 (NCT00129233).
The NAGOYA HEART Study was funded and supported by Nagoya University Graduate School of Medicine (Nagoya, Japan). The Department of Cardiology, Nagoya University Graduate School of Medicine reported receiving research promotion grants (Shougaku Kifukin) from Actelion (Tokyo, Japan), Astellas (Tokyo, Japan), Bayer (Osaka, Japan), Boehringer Ingelheim (Tokyo, Japan), Chugai (Tokyo, Japan), Daiichi Sankyo (Tokyo, Japan), Dainippon Sumitomo (Osaka, Japan), Eisai (Tokyo, Japan), Fujifilm RI (Tokyo, Japan), Kaken (Tokyo, Japan), Kowa (Nagoya, Japan), Kureha (Tokyo, Japan), Medtronic (Tokyo, Japan), Mitsubishi Tanabe (Osaka, Japan), Mochida (Tokyo, Japan), MSD (Tokyo, Japan), Novartis (Tokyo, Japan), Pfizer (Tokyo, Japan), Sanofi-Aventis (Tokyo, Japan), Schering-Plough (Osaka, Japan), and Takeda (Osaka, Japan). However, the research topics of these donation grants are not restricted.
See page 1755 for disclosure information.
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