A Review of the Use of Angiotensin Receptor Blockers for the Prevention of Cardiovascular Events in Patients with Essential Hypertension Without Compelling Indications

• Published in: The Annals of pharmacotherapy Vol. 47; no. 5; pp. 686 - 693
• Main Authors: Zaiken, Kathy, Hudd, Timothy R, Cheng, Judy WM
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-05-2013; Whitney
• Subjects: Angiotensin Receptor Antagonists - administration & dosage; Angiotensin Receptor Antagonists - therapeutic use; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - prevention & control; Humans; Hypertension - drug therapy; Hypertension - epidemiology; Medical sciences; Pharmacology. Drug treatments; Risk Factors; Human; Hypertension; Prevention; Indication; Cardiovascular disease; Angiotensin antagonist; Review; Bibliographic review
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1345/aph.1R273

OBJECTIVE
To review the role of angiotensin receptor blockers (ARBs) for the prevention of cardiovascular events in patients with essential hypertension without other compelling indications.
DATA SOURCES
Peer-reviewed clinical trials, review articles, and relevant treatment guidelines were identified from MEDLINE and Current Content database (both 1966-November 15, 2012) using the search terms angiotensin receptor blockers (ARBs), azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan, hypertension, myocardial infarction, stroke, heart failure, and cardiovascular outcomes. Results were limited to human trials published in English. Citations from articles were also reviewed for additional references.
STUDY SELECTION AND DATA EXTRACTION
The focus was on clinical trials evaluating cardiovascular end points of ARBs used in patients with essential hypertension without compelling indications.
DATA SYNTHESIS
Data supporting the use of ARBs for reducing cardiovascular events in patients with essential hypertension without compelling indications are inconsistent. To date, only candesartan and losartan have shown a significant reduction in cardiovascular morbidity within this sizable subgroup of patients. In the Study on Cognition and Prognosis in the Elderly (SCOPE) trial, candesartan showed a 27.8% reduction in nonfatal stroke versus placebo (95% CI 1.3–47.2; p = 0.04). Moreover, losartan demonstrated a decrease in all cardiovascular events compared to atenolol in the Cardiovascular Morbidity and Mortality in the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study (RR 0.87; 95% CI 0.77–0.98; p = 0.021).
CONCLUSIONS
Data supporting the use of ARBs for reducing cardiovascular events in patients with essential hypertension without compelling indications are limited and inconclusive. More studies are needed before ARBs can be routinely recommended as first-line therapy for hypertension management in patients without other compelling indications.