Do irbesartan and amlodipine reduce cardiovascular events in diabetic patients?

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Q&A

Do irbesartan and amlodipine reduce cardiovascular events in diabetic patients?

J Fam Pract. 2003 August;52(8):587-604

By

Peter S. Millard, MD, PhD

BACKGROUND: Good control of blood pressure reduces microvascular and macrovascular complications in patients with diabetes more than control of blood glucose levels.¹ Further, the Antihypertensive and Lipid Lowering Treatment to prevent Heart Attack Trial (ALLHAT) demonstrated that diuretics should be first-line therapy for all patients with hypertension, including those with diabetes.²
POPULATION STUDIED: This randomized, multinational study enrolled 1715 patients with type 2 diabetes, blood pressure >135/85 mm Hg, and frank nephropathy (mean 2.9 g/d of urinary protein). Two thirds of the patients also had retinopathy, nearly 30% had pre-existing cardiovascular disease, and over half took insulin. Patients were receiving multiple-drug antihypertensive regimens from their primary care physicians; those already taking ARBs, calcium channel blockers, or angiotensin-converting enzyme inhibitors were excluded.
STUDY DESIGN AND VALIDITY: In addition to their usual antihypertensive treatment, patients were assigned to receive either placebo, amlodipine (Norvasc) 10 mg/d, or irbesartan (Avapro) 300 mg/d. Allocation to treatment assignment was concealed, and patients and investigators were blinded to treatment assignment. Patients were followed for 2.5 years; loss to follow-up was less than 1%. Analysis was by intention-to-treat.
OUTCOMES MEASURED: The combined outcome was the occurrence of at least 1 of the following: any acute myocardial infarction, unplanned coronary revascularization procedure, heart failure, stroke, or fatal coronary heart disease. Each outcome was also examined individually.
RESULTS: Differences were small among the groups at baseline, but the investigators appropriately accounted for these differences in the analysis. Nearly one quarter of the patients discontinued the assigned treatment prematurely (mostly due to complications of therapy, protocol violations, or uncontrolled hypertension).

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Do irbesartan and amlodipine reduce cardiovascular events in diabetic patients?

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