The Impact of Different Antihypertensive Drugs on Cardiovascular Risk in Isolated Systolic Hypertension with Type 2 Diabetes Patients

Abstract

Backgrounds: Angiotensin receptor blockers (ARB), angiotensin converting enzyme inhibitor (ACEI), calcium channel blocker (CCB) and thiazide diuretics (TD) are common antihypertensive drugs for diabetes patients with hypertension. The purpose of this study was to compare the cardiovascular risks of these drugs in patients with isolated systolic hypertension (ISH) and type 2 diabetes mellitus (T2DM). Methods: We used Action to Control Cardiovascular Risk in Diabetes trial data to explore the relationship between antihypertensive drugs and cardiovascular risks in ISH with T2DM patients by performing propensity score matching, Kaplan–Meier survival analyses and Cox proportional regression. Results: The cumulative incidence rates of primary outcomes (PO, including cardiovascular mortality, non-fatal myocardial infarction and non-fatal stroke) in the ARB use group were significantly lower than those without (hazard ratio (HR) 0.53; 95% confidence interval (CI) 0.34–0.83; p = 0.006). However, for ACEI, CCB and TD, they were negligible (ACEI: p = 0.209; CCB: p = 0.245; TD: p = 0.438). ARB decreased cardiovascular mortality (CM) in PO rather than non-fatal myocardial infarction (NMI) and non-fatal stroke (NST) (CM: HR 0.32; 95%CI 0.18–0.90; p = 0.004; NMI: p = 0.692; NST: p = 0.933). Conclusion: ARB may alleviate the cardiovascular risks in ISH with T2DM patients, but ACEI, CCB, and TD did not.

Impact of calcium channel blockers and angiotensin receptor blockers on hematological parameters in type 2 diabetic patients

“…As antihypertensive agents, the results of this study showed an acceptable blood lowering effects for both, ARBs and CCBs, with more potent action from ARBs in comparison to CCBs. This is in consistence with the previous researches, where both groups have been used for controlling BP in diabetic patients and that ARBs are superior to all other classes (15,16).…”

New Users of Angiotensin II Receptor Blocker–Versus Angiotensin‐Converting Enzyme Inhibitor–Based Antihypertensive Medication Regimens and Cardiovascular Disease Events: A Secondary Analysis of ACCORD‐BP and SPRINT

“… 3 In a prior analysis of ACCORD‐BP, Gao et al observed that participants who were prevalent users of ARBs at baseline experienced lower rates of the primary outcome during the trial, but did not observe the same relationship with ACEIs, calcium channel blockers, or thiazide diuretics. 27 However, this analysis is subject to prevalent user bias, and the results should be interpreted with great caution. The current American College of Cardiology/American Heart Association and the European Society of Cardiology/European Society of Hypertension BP guidelines recommend both classes interchangeably, 1 , 28 and there may be further evidence that ARBs provide more protection against hypertension‐mediated cognitive decline and cancer outcomes.…”