Long-term mortality and cardiovascular events of seven angiotensin receptor blockers in hypertensive patients: Analysis of a national real-world database: A retrospective cohort study

Wonjae Lee; Jeehoon Kang; Jun-Bean Park; Won-Woo Seo; Seung-Yeon Lee; Woo-Hyun Lim; Ki-Hyun Jeon; In-Chang Hwang; Hack-Lyoung Kim

doi:10.1002/hsr2.1056

Long-term mortality and cardiovascular events of seven angiotensin receptor blockers in hypertensive patients: Analysis of a national real-world database: A retrospective cohort study

Health Sci Rep. 2023 Jan 31;6(2):e1056. doi: 10.1002/hsr2.1056. eCollection 2023 Feb.

Authors

Wonjae Lee¹, Jeehoon Kang², Jun-Bean Park², Won-Woo Seo³, Seung-Yeon Lee⁴, Woo-Hyun Lim⁵, Ki-Hyun Jeon¹, In-Chang Hwang¹, Hack-Lyoung Kim⁵

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Cardiovascular Center Seoul National University Bundang Hospital Seongnam-si Gyeonggi-do South Korea.
² Division of Cardiology, Department of Internal Medicine Seoul National University Hospital Seoul South Korea.
³ Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital Hallym University Seoul South Korea.
⁴ International Healthcare Center Seoul National University Bundang Hospital Seongnam-si Gyeonggi-do South Korea.
⁵ Division of Cardiology, Department of Internal Medicine, Boramae Medical Center Seoul National University College of Medicine Seoul South Korea.

Abstract

Background and aims: Although many angiotensin receptor blockers (ARBs) are widely used, comparative data regarding their impact on clinical outcomes are limited. We aimed to compare the clinical effectiveness of seven ARBs on long-term cardiovascular outcomes in Korean patients with hypertension.

Methods: Using the Korean National Health Insurance Service database, the data of 780,785 patients with hypertension without cardiovascular disease (CVD) who initiated ARB treatment (candesartan, fimasartan, irbesartan, losartan, olmesartan, telmisartan, or valsartan) in 2014 and underwent this treatment for more than 6 months, were analyzed. Cox-regression analysis was performed using Losartan as a comparator, as it was the most widely used drug, by adjusting age, sex, diabetes, dyslipidemia, smoking, alcohol drinking, exercise, body mass index, systolic blood pressure, albuminuria, estimated glomerular filtration rate, and concomitant medications. The occurrence of mortality and the rate of major adverse cardiovascular events (MACEs) of the six ARBs was compared with that of losartan.

Results: The median follow-up duration was 5.94 (interquartile range, 5.87-5.97) years. In the crude analysis of all-cause mortality and MACEs, fimasartan exhibited the lowest event rates. In the Cox-regression analysis with adjustment, there was no significant difference in all-cause mortality among ARBs. The risk of MACEs with ARBs was similar to that with losartan, although the risks with irbesartan (hazard ratio [HR], 1.079; 95% confidence interval [CI], 1.033-1.127; p = 0.007) and candesartan (HR: 1.066; 95% CI, 1.028-1.106; p = 0.015) were slightly higher.

Conclusion: In a Korean population of patients with hypertension without CVD, six different ARBs showed similar efficacy to losartan in terms of long-term mortality and MACEs. Further well-designed prospective studies are required to confirm our findings.

Keywords: angiotensin receptor blocker; cardiovascular event; hypertension; mortality; prognosis.