Table 2.
Selected outcomes from randomized clinical trials of ARBs
| Drug | Atherosclerosis | Hypertensive LVH | 2° prevention post-MI | Stroke | Heart failure | Atrial fibrillation | Renoprotection |
|---|---|---|---|---|---|---|---|
| Losartan | +/− |
+ (LIFE) |
− (OPTIMAL) |
+ (LIFE*) 2° prevent: + (LIFE) |
+/− (ELITE/ELITE II) |
1° prevent: + (LIFE) |
+ (RENAAL, JLIGHT, ROAD) |
| Valsartan |
+ (MARVAL-2, VIP) |
+ |
+ (T-VENTURE, VALIANT) |
+ (Jikei Heart*, Kyoto HEART*) |
+ (Val-HeFT) |
1° prevent: + (Val-HeFT) 2° prevent: − GISSI-AF) |
+ (VALERIA, SMART, HKVIN, MARVAL, MARVAL-2) |
| Candesartan |
+ (CENTRO, MIT EC) |
+ (CATCH, CASE-J) |
+ (E-COST) |
+ (SCOPE*) 1° prevent: − (E-COST) 2° prevent: + (E-COST) |
+ (RESOLVD, CHARM) |
2° prevent: − (CAPRAF) |
+/− (DIRECT, CENTRO) |
| Irbesartan |
+ (EPAS, ISLAND, SILVHIA) |
+ (SILVHIA, CVIP) |
+ (I-PRESERVE) |
2° prevent: + |
+/− (IRMA-2, IDNT, IMPROVE) |
||
| Telmisartan | + |
+ (ONTARGET/TRANSCEND) |
− (TRANSCEND*,†) 2° prevent: − (PROFESS) |
+ (REPLACE) |
1° prevent: + |
+/− (INNOVATION, TRANSCEND, ONTARGET, DETAIL) |
|
| Eprosartan | + | + | 2° prevent: + (MOSES) |
+ (ADEPT) |
|||
| Olmesartan |
+ (EUTOPIA) |
− |
Reprinted from Advances in Therapy®, volume 27, issue 5, Siragy, ‘Comparing angiotensin II receptors on benefits beyond blood pressure’, pp 257–284, Copyright 2010, with permission from Springer.20
Notes:
designates that the study achieved its primary or secondary endpoint(s);
designates that study did not meet its primary or secondary endpoint(s); This table is a summary of fully published randomized controlled trial data (ie, no data from single-arm noncomparative trials were considered), with an emphasis on large-scale trials (when available). Additional smaller studies were considered in the absence of data from large-scale clinical trials;
Stroke data were not specific to primary or secondary prevention in the main analysis;
Stroke was evaluated in a post-hoc analysis, not as a prespecified endpoint.
Abbreviations: ADEPT, Addition of the AT1 Receptor Antagonist Eprosartan to ACE Inhibitor Therapy in Chronic Heart Failure trial; ARBs, angiotensin receptor blockers; CAPRAF, Candesartan in the Prevention of Relapsing Atrial Fibrillation; CASE-J, Candesartan Antihypertensive Survival Evaluation in Japan; CATCH, Candesartan Assessment in the Treatment of Cardiac Hypertrophy; CENTRO, Candesartan on Atherosclerotic Risk Factors; CHARM, Candesartan in Heart Failure Assessment in Reduction of Mortality; CVIP, Cardiovascular Irbesartan Project; DETAIL, Diabetics Exposed to Telmisartan and Enalapril; DIRECT, Diabetic Retinopathy Candesartan Trials; E-COST, Efficacy of Candesartan on Outcome in Saitama Trial; ELITE, Evaluation of Losartan in the Elderly; EPAS, Endothelial Protection, AT1 Blockade and Cholesterol-Dependent Oxidative Stress; EUTOPIA, European Trial on Olmesartan and Pravastatin in Inflammation and Atherosclerosis; GISSI-AF, Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico–Atrial Fibrillation; HKVIN, Hong Kong Study Using Valsartan in IgA Nephropathy; IDNT, Irbesartan in Diabetic Nephropathy Trial; IMPROVE, Irbesartan in the Management of Proteinuric Patients at High Risk of Vascular Events; INNOVATION, Incipient to Overt: Angiotensin II Blocker, Telmisartan, Investigation on Type 2 Diabetic Nephropathy; I-PRESERVE, Irbesartan in Heart Failure with Preserved Systolic Function; IRMA-2, Irbesartan in Microalbuminuria, Type 2 Diabetic Nephropathy Trial; ISLAND, Irbesartan and Lipoic Acid in Endothelial Dysfunction; JLIGHT, Japanese Losartan Therapy Intended for the Global Renal Protection in Hypertensive Patients; LIFE, Losartan Intervention For Endpoint Reduction in Hypertension; LVH, left ventricular hypertrophy; MARVEL/MARVEL-2, Microalbuminuria Reduction with Valsartan; MI, myocardial infarction; MIT-EC, Media Intima Thickness Evaluation with Candesartan Cilexetil; MOSES, Morbidity and Mortality after Stroke, Eprosartan Compared with Nitrendipine for Secondary Prevention; OPTIMAL, Optimal Trial In Myocardial Infarction with the Angiotensin Receptor Blocker Losartan; ONTARGET, Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial; PROFESS, The Prevention Regimen for Effectively Avoiding Second Strokes Trial; RENAAL, Reduction of Endpoints in Non-insulin-dependent Diabetes Mellitus with Angiotensin II Antagonist Losartan; REPLACE, Replacement of Angiotensin-Converting Enzyme Inhibition; RESOLVD, Randomized Evaluation of Strategies for Left Ventricular Dysfunction; ROAD, Renoprotection of Optimal Antiproteinuric Doses; SCOPE, Study on Cognition and Prognosis in the Elderly; SILVHIA, Swedish Irbesartan Left Ventricular Hypertrophy Versus Atenolol; SMART, Shiga Microalbuminuria Reduction Trial; TRANSCEND, Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease; T-VENTURE, Inhibitory Effect of Valsartan against Progression of Left Ventricular Dysfunction after Myocardial Infarction; VALERIA, Valsartan in Combination with Lisinopril in Hypertensive Patients with Microalbuminuria; VALIANT, Valsartan in Acute Myocardial Infarction; Val-HeFT, Valsartan Heart Failure Trial; VIP, Valsartan Inhibits Platelets.