Risk of myocardial infarction, heart failure, and cerebrovascular disease with the use of angiotensin receptor blockers: a retrospective cohort study

Abstract

AbstractBackground:There is a lack of studies comparing the risk of cardio-cerebrovascular disease between angiotensin receptor blockers (ARBs) of different half-lives.Aim:To compare the risks of myocardial infarction, heart failure, and cerebrovascular disease with the use of ARBs with different half-lives in a retrospective cohort of patients aged ≥ 40 years with hypertension.Method:We performed propensity score matching to establish a cohort of 148,229 patients exposed to valsartan, losartan, irbesartan, or telmisartan. We used an as-treated approach to evaluate exposure and the Cox regression logistic model to calculate the incidence rates and adjusted hazard ratios (aHRs, 95% confidence interval) for MI, heart failure, and cerebrovascular disease with valsartan, losartan, and irbesartan compared to telmisartan.Results:The matched cohort analysis showed that the risk of myocardial infarction was higher for valsartan use (1.39, 1.33–1.45) and losartan use (1.10, 1.05–1.15) but lower for irbesartan use (0.90, 0.86-0.94) than telmisartan use. Compared with telmisartan use, the risk for cerebrovascular disease was lower for valsartan use (0.85, 0.83–0.87) and losartan use (0.80, 0.78–0.82) but higher for irbesartan use (1.11, 1.09–1.13).Conclusion:We found differences in the risk of myocardial infarction and cerebrovascular disease with the use of ARBs with different half-lives. Valsartan and losartan with a short half-life, which showed a higher risk of myocardial infarction, had a lower risk of cerebrovascular disease. Conversely, irbesartan with a long half-life, which showed a lower risk of myocardial infarction, had a higher risk of cerebrovascular disease.