Table 2.
Hazard ratios (HRs) for valsartan, losartan, and irbesartan, with telmisartan as the reference drug, in both the overall and matched cohorts.
| Outcome | Exposure | Overall cohort | ||||||
|---|---|---|---|---|---|---|---|---|
| No. of patients | No. of event | Person yr | Incidence rate per 1000 Person-Yr | Crude HR (95% CI) | Adjusted* HR (95% CI) | Note | ||
| Myocardial infarction | Valsartan | 375,465 | 18,799 | 324,746.85 | 57.89 | 2.30 (2.24–2.36) | 1.50 (1.46–1.54) | †Short |
| Losartan | 565,041 | 12,794 | 447,815.50 | 28.57 | 1.09 (1.06–1.12) | 1.11 (1.08–1.15) | Short | |
| Irbesartan | 148,229 | 3456 | 151,743.84 | 22.78 | 1.01 (0.97–1.05)$ | 0.90 (0.87–0.94) | †Long | |
| Telmisartan | 331,796 | 7194 | 283,463.70 | 25.38 | Ref. | Ref. | Long | |
| Heart failure | Valsartan | 375,465 | 11,139 | 334,938.81 | 33.26 | 1.66 (1.61–1.71) | 1.32 (1.27–1.36) | ‡Approval |
| Losartan | 565,041 | 10,732 | 448,113.15 | 23.95 | 1.12 (1.08–1.15) | 0.95 (0.92–0.98) | ||
| Irbesartan | 148,229 | 2584 | 153,205.98 | 16.87 | 0.93 (0.89–0.98)$$ | 0.87 (0.83–0.91) | ||
| Telmisartan | 331,796 | 5867 | 284,367.16 | 20.63 | Ref. | Ref. | ||
| Cerebrovascular disease | Valsartan | 375,465 | 23,177 | 322,996.95 | 71.76 | 0.74 (0.73–0.75) | 0.70 (0.69–0.72) | |
| Losartan | 565,041 | 30,869 | 427,467.68 | 72.21 | 0.69 (0.68–0.70) | 0.67 (0.66–0.68) | ‡‡Approval | |
| Irbesartan | 148,229 | 18,425 | 134,559.93 | 136.93 | 1.49 (1.47–1.52) | 1.40 (1.37–1.42) | ||
| Telmisartan | 331,796 | 26,822 | 260,134.63 | 103.11 | Ref. | Ref. | ||
| Cerebral infarction | Valsartan | 375,465 | 17,431 | 330,745.40 | 52.70 | 0.72 (0.71–0.74) | 0.69 (0.68–0.71) | |
| Losartan | 565,041 | 22,349 | 437,374.15 | 51.10 | 0.65 (0.64–0.66) | 0.64 (0.63–0.65) | ||
| Irbesartan | 148,229 | 13,728 | 140,027.64 | 98.04 | 1.43 (1.40–1.47) | 1.31 (1.29–1.34) | ||
| Telmisartan | 331,796 | 20,692 | 267,242.72 | 77.43 | Ref. | Ref. | ||
| Outcome | Exposure | Matched cohort by PS | ||||||
|---|---|---|---|---|---|---|---|---|
| No. of patients | No. of event | Person yr | Incidence rate per 1000 Person-Yr | Crude HR (95% CI) | Adjusted* HR (95% CI) | Note | ||
| Myocardial infarction | Valsartan | 148,229 | 5618 | 133,779.61 | 41.99 | 1.48 (1.42–1.54) | 1.39 (1.33–1.45) | †Short |
| Losartan | 148,229 | 4067 | 125,129.67 | 32.50 | 1.11 (1.06–1.16) | 1.10 (1.05–1.15) | Short | |
| Irbesartan | 148,229 | 3456 | 151,743.84 | 22.78 | 0.87 (0.84–0.92) | 0.90 (0.86–0.94) | †Long | |
| Telmisartan | 148,229 | 3756 | 130,417.75 | 28.80 | Ref. | Ref. | Long | |
| Heart failure | Valsartan | 148,229 | 2904 | 137,043.84 | 21.19 | 1.07 (1.02–1.13)! | 1.05 (0.99–1.10)!! | ‡Approval |
| Losartan | 148,229 | 2493 | 126,756.92 | 19.67 | 0.96 (0.90–1.01)!! | 0.95 (0.90–1.00)# | ||
| Irbesartan | 148,229 | 2584 | 153,205.98 | 16.87 | 0.92 (0.88–0.98)!!! | 0.94 (0.89–1.00)## | ||
| Telmisartan | 148,229 | 2672 | 131,754.08 | 20.28 | Ref. | Ref. | ||
| Cerebrovascular disease | Valsartan | 148,229 | 14,046 | 124,475.36 | 112.84 | 0.85 (0.83–0.87) | 0.85 (0.83–0.87) | |
| Losartan | 148,229 | 12,662 | 115,586.37 | 109.55 | 0.79 (0.77–0.81) | 0.80 (0.78–0.82) | ‡‡Approval | |
| Irbesartan | 148,229 | 18,425 | 134,559.93 | 136.93 | 1.10 (1.08–1.12) | 1.11 (1.09–1.13) | ||
| Telmisartan | 148,229 | 16,175 | 115,935.76 | 139.52 | Ref. | Ref. | ||
| Cerebral infarction | Valsartan | 148,229 | 10,720 | 128,790.07 | 83.24 | 0.83 (0.81–0.85) | 0.84 (0.82–0.86) | |
| Losartan | 148,229 | 9342 | 119,221.71 | 78.36 | 0.75 (0.73–0.77) | 0.76 (0.74–0.78) | ||
| Irbesartan | 148,229 | 13,728 | 140,027.64 | 98.04 | 1.05 (0.81–0.85) | 1.07 (1.04–1.09) | ||
| Telmisartan | 148,229 | 12,596 | 119,851.86 | 105.1 | Ref. | Ref. | ||
95% CI = confidence interval, HR = hazard ratio, PS = propensity score, Ref = reference.
$P=0.535,
$
$P=0.003.
!P=0.011,
!!P=0.099,
!!!P=0.005.
*
A multivariate Cox proportional hazard model.
†
half-life classification.
‡
US & EU (Heart Failure and Post-Myocardial Infarction indicated to reduce the risk of cardiovascular mortality),
‡‡
US & EU (Reduction of the risk of stroke in patients with hypertension).
#P = .067,
##P = .039.