Friday, April 08, 2011


This paper was also presented at the just concluded 60th Annual Scientific meeting of ACC 2011.
The study was led by Dr Toyoaki Murohara of Nagoya University. I am very pleased to note that the Japanese, and also the Koreans, are putting out more and more papers in big American meetings. I have always felt that Asian Trials are much more applicable to us.
Anyway, Dr Murohara and colleagues studied 1150 patients with T2DM ( 82% confirmed T2DM and 18% IGT ) and hypertension. They wanted to study the effect of using either a CCB ( norvasc ) or an ARB ( Valsartan ), in the control of the hypertension and their effects on cardiac major adverse events ( MACCE ), including heart attacks, strokes, need for revascularisation, admission for heart failure, and sudden cardiac death. This is probably the largest such trial in hypertensive diabetics.
After 3.2 years of follow-up, they found that both agents did just as well. They were essentially equivalent, for the primary end-point. Of course the BP control and HbA1c control were equivalent.
The only difference was in admission for heart failure. In this subset, valsartan was better. Less patients on Valsartan needed to be admotted for CCF during the study period ( and these are patients who had LVEF>40% at the start of study ).
I was looking high and low for the effect of these regimes, on renal function. I could not find it. Obviously because ARBs are suppose to protect the kidneys in patient with diabetes and hypertension. In Japan, ACE-I are unpopular because of the problem of cough with ACE-I.
The other issue is of course, duration of study. It could be that at 3.2 years, the differences have not shown yet. It would be interesting to see the outcomes at 5, 7 and 10years.
We will be discussing more about this at the coming " Weekend seminar in Cardiology for GPs 2011" this Saturday, over dinner sponsored by Pfizer.

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