Saturday, July 13, 2013


The latest information on ARB was published in the Canadian Medical Association Journal, 8th July. The article is entitled, "Comparative effectiveness of angiotensin-receptor blockers for preventing macrovascular disease in patients with diabetes: a population-based cohort study". The lead author s Dr Tony Antoniou of St Michael's Hospital, Toronto, Canada.

They studied, retrospectively, 54,186 patients who were dabetics for 6 years or more and who were also on ARBs for a variety of reasons including hypertension and heart failure. After 10 years of followup ( 2001-2011 ) they found that the use of Telmisartan and valsartan was associated with a 15% and 14% reduction in the primary endpoint of less admissions for AMIs, CCF and strokes. The average age of the cohort was 73 years.
Risk of the composite outcome of hospitalization for MI, stroke, or heart failure

Drug Adjusted hazard ratio (95% CI) 
Irbesartan 1.00 (reference)
Telmisartan 0.85 (0.74-0.97)
Candesartan 0.99 (0.89-1.11)
Losartan 0.93 (0.83-1.05)
Valsartan 0.86 (0.77-0.96)

What is also interesting is that in this cohort, physicians in Canadian prescribed Candesartan in 20.2% of patients, Telmisartan in 15.1%, Irbesartan in 23.4% Losartan in 15.5% an Valsartan in 25.8%.

In their analysis, Dr Antoniou et al also that Losartan was the weakest ARB.

This is a retrospective analysis, but which such a large cohort ( 54,000 patients ), their findings should carry some weight in decision making.

There is also some good theorectical basis. Telmisartan after all does have a partial peroxisome proliferator activator receptor gamma ( ppar gamma ) agonist effect. The ppar gamma lignd does affect lipid metabolism and also insulin sensitivity. Maybe that is why. 

I suppose what this study teaches me is that in T2DMs, if I have to use an ARB, I should prefer Telmisartan or Valsartan,  in an attempt to reduce the macrovascular complications of diabetes. That makes sense.

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