ARB Compared with non-ARB in Preventing Cardiac Events in High Risk Hypertensive Patients: An Evidence Based Case Report
Abstract
Background: High risk hypertensive patients have an increased risk of developing cardiovascular complication. It is better to use a proven cardio protective drugs to reduce blood pressure in high risk hypertensive patients. Angiotensin II receptor Blocker (ARB) is one type of antihyper-tensive drugs with cardioprotective effect for hypertensive patients withoutother risk factor. Whether cardioprotective effect of ARB also apply for a more specific population such as high risk hypertensive patients need to be investigated.
Aim: To determine the efficacy of ARB compared to non-ARBs in preventing cardiac event in a more specific population, such as high risk hypertensive patients.
Methods: A search was conducted on PubMed and Cochrane. The selection of title and abstract was done using inclusion and exclusion criterias. Three original articles were found and used as the evidence tor the clinical question. The selected studies were critically appraised for validity, importance and applicability.
Result: According to Sawada et al, the blood pressure lowering effect was similar between valsartan and non-ARB groups. The cardiovascular events in valsartan group is lower compared to non-ARB groups (relative risk: 0.54, 95% confidence interval 0.4-0.7, p< 0.001). The administration of valsartan as compared to non-ARB, also reduce the occurence of angina pectoris (Relative risk: 0.52, 95% Confidence Interval 0.31–0.86, P=0.01058). Cohn JN et al showed that there was no significant differences in the candesartan group in terms of total death and primary endpoints. The only significant finding in this article was the lower rate of diabetes mellitus in the candesartan group.
Conclusion: Valsartan, as compared to non-ARB, reduce cardic event in high risk hypertensive patients.
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References
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Bonow RO, Smaha LA, Smith SC, Mensah GA, Lenfant C. World Heart Day 2002: The International Burden of Cardio-vascular Disease: Responding to the Emerging Global Epidemic. Circulation2002, 106:1602-05.
Kavey REW, Daniels SR, Lauer RM, Atkins DL, Hayman LL and Taubert K. American heart Association Guidelines for Primary Prevention of Atherosclerotic Cardiovascular Disease Beginning in Childhood. Circulation 2003, 107:1562-66.
Stults B and Jones RE. Management of Hypertension in Dia-betes. Diabetes Spectrum, 2006, 19(1):25-31.
Birkenhäger WH, de Leeuw PW. Non-peptide Angiotensin type 1 Receptor Antagonists in The Treatmentof Hypertension. J Hypertens1999;17:873-81.
Wang JG, Li Y, Franklin SS, Safar M. Prevention of Stroke and Myocardial Infarction by Amlodipine and Angiotensin Receptor Blockers: A Quantitative Overview. Hypertension 2007;50:181-8.
Pfeffer MA, McMurray JJV, Velasquez EJ, Rouleau JL, Kober L, Maggioni AP et al. Valsartan, Captopril, or Both in Myocar-dial Infarction Complicated by Heart Failure, Left Ventricular Dysfunction, or Both. N Eng J Med 2003;349:1893-1906.
Sawada T, Yamada H, Dahlof B, Matsubara H. Effects of Vasar-tan on Morbidity and Mortality in Uncontrolled Hypertensive Patients with High Cardiovascular Risk: Kyoto Heart Study. Eur Heart Journal 2009; 30: 2461-69.
Kasanuki H, Hagiwara N, Hosada S, Sumiyoshi T, Honda T, Haze K et al.Angiotensin II receptor blocker-based vs non-angiotensin II receptor blocker-based therapy in patients with angiographically documented coronary artery disease and hyper-tension: the Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Artery Disease (HIJ-CREATE). European Heart Journal 2009; 30: 1203-12.
Cohn JN, Tognoni G. A randomized trial of the angiotensin-receptor blocker valsartanin chronic heart failure. N Engl J Med 2001; 345:1667–75.
Centre for Evidence Based Medicine. Oxford Centre for Evidence-based Medicine- Level of Evidence. CEBM. [cited 2012 Febuary 5]. Available from: http://www.cebm.net/index.aspx?o=5513
Julius S, Weber MA, Kjeldsen SE, McInnes GT, Zanchetti A, Brunner HR et al. The valsartan antihypertensive long-term use evaluation (VALUE) trial: outcomes in patiens receiving monotherapy. Hypertension 2006; 48:385-91)
The ONTARGET Investigators. Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events. N Eng J Med 2008; 358:1547-59.
Pfeffer MA, McMurray JJV, Velazquez EJ, Rouleau JL, Kober L,Maggioni AP et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunc-tion, or both.N Eng J med 2003; 349:1893-906.
Bonow RO, Smaha LA, Smith SC, Mensah GA, Lenfant C. World Heart Day 2002: The International Burden of Cardio-vascular Disease: Responding to the Emerging Global Epidemic. Circulation2002, 106:1602-05.
Kavey REW, Daniels SR, Lauer RM, Atkins DL, Hayman LL and Taubert K. American heart Association Guidelines for Primary Prevention of Atherosclerotic Cardiovascular Disease Beginning in Childhood. Circulation 2003, 107:1562-66.
Stults B and Jones RE. Management of Hypertension in Dia-betes. Diabetes Spectrum, 2006, 19(1):25-31.
Birkenhäger WH, de Leeuw PW. Non-peptide Angiotensin type 1 Receptor Antagonists in The Treatmentof Hypertension. J Hypertens1999;17:873-81.
Wang JG, Li Y, Franklin SS, Safar M. Prevention of Stroke and Myocardial Infarction by Amlodipine and Angiotensin Receptor Blockers: A Quantitative Overview. Hypertension 2007;50:181-8.
Pfeffer MA, McMurray JJV, Velasquez EJ, Rouleau JL, Kober L, Maggioni AP et al. Valsartan, Captopril, or Both in Myocar-dial Infarction Complicated by Heart Failure, Left Ventricular Dysfunction, or Both. N Eng J Med 2003;349:1893-1906.
Sawada T, Yamada H, Dahlof B, Matsubara H. Effects of Vasar-tan on Morbidity and Mortality in Uncontrolled Hypertensive Patients with High Cardiovascular Risk: Kyoto Heart Study. Eur Heart Journal 2009; 30: 2461-69.
Kasanuki H, Hagiwara N, Hosada S, Sumiyoshi T, Honda T, Haze K et al.Angiotensin II receptor blocker-based vs non-angiotensin II receptor blocker-based therapy in patients with angiographically documented coronary artery disease and hyper-tension: the Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Artery Disease (HIJ-CREATE). European Heart Journal 2009; 30: 1203-12.
Cohn JN, Tognoni G. A randomized trial of the angiotensin-receptor blocker valsartanin chronic heart failure. N Engl J Med 2001; 345:1667–75.
Centre for Evidence Based Medicine. Oxford Centre for Evidence-based Medicine- Level of Evidence. CEBM. [cited 2012 Febuary 5]. Available from: http://www.cebm.net/index.aspx?o=5513
Julius S, Weber MA, Kjeldsen SE, McInnes GT, Zanchetti A, Brunner HR et al. The valsartan antihypertensive long-term use evaluation (VALUE) trial: outcomes in patiens receiving monotherapy. Hypertension 2006; 48:385-91)
The ONTARGET Investigators. Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events. N Eng J Med 2008; 358:1547-59.
Pfeffer MA, McMurray JJV, Velazquez EJ, Rouleau JL, Kober L,Maggioni AP et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunc-tion, or both.N Eng J med 2003; 349:1893-906.
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How to Cite
Nursalim, A., & Yuniadi, Y. (1). ARB Compared with non-ARB in Preventing Cardiac Events in High Risk Hypertensive Patients: An Evidence Based Case Report. Indonesian Journal of Cardiology, 33(2), 91-8. https://doi.org/10.30701/ijc.v33i2.59
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Case Reports
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