1. Clinical impacts of additive use of olmesartan in hypertensive patients with chronic heart failure: the supplemental benefit of an angiotensin receptor blocker in hypertensive patients with stable heart failure using olmesartan (SUPPORT) trial
- Author
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Sakata, Yasuhiko, Shiba, Nobuyuki, Takahashi, Jun, Miyata, Satoshi, Nochioka, Kotaro, Miura, Masanobu, Takada, Tsuyoshi, Saga, Chiharu, Shinozaki, Tsuyoshi, Sugi, Masafumi, Nakagawa, Makoto, Sekiguchi, Nobuyo, Komaru, Tatsuya, Kato, Atsushi, Fukuchi, Mitsumasa, Nozaki, Eiji, Hiramoto, Tetsuya, Inoue, Kanichi, Goto, Toshikazu, Ohe, Masatoshi, Tamaki, Kenji, Ibayashi, Setsuro, Ishide, Nobumasa, Maruyama, Yukio, Tsuji, Ichiro, Shimokawa, Hiroaki, Shimokawa, H., Fukuchi, M., Goto, T., Hiramoto, T., Inoue, K., Kato, A., Komaru, T., Ohe, M., Sekiguchi, N., Shiba, N., Shinozaki, T., Sugi, M., Tamaki, K., Ogata, M., Sato, S., Ishide, N., Ibayashi, S., Maruyama, Y., Ohno, I., Ogawa, H., Kitakaze, M., Tsuji, I., Watanabe, T., Sugiyama, K., Oyama, S., Nozaki, E., Nakamura, A., Takahashi, T., Endo, H., Fukui, S., Nakajima, S., Nakagawa, M., Nozaki, T., Yagi, T., Horiguchi, S., Fushimi, E., Sugai, Y., Takeda, S., Fukahori, K., Aizawa, K., Tashima, T., Sakurai, K., Kobayashi, T., Matsui, M., Tamada, Y., Yahagi, T., Fukui, A., Takahashi, K., Kikuchi, Y., Akai, K., Kanno, H., Kaneko, J., Suzuki, S., Katayose, D., Onodera, S., Komatsu, S., Chida, M., Iwabuchi, K., Takeuchi, M., Yahagi, H., Takahashi, N., Otsuka, K., Koseki, Y., Morita, M., Ishizuka, T., Onoue, N., Yamaguchi, N., Fujita, H., Katoh, A., Namiuchi, S., Sugie, T., Saji, K., Takii, T., Sugimura, A., Ohashi, J., Tanikawa, T., Kitamukai, O., Matsumoto, Y., Koyama, J., Tomioka, T., Shioiri, H., Ito, Y., Kato, H., Takahashi, C., Kawana, A., Sakata, Y., Ito, K., Nakayama, M., Fukuda, K., Takahashi, J., Miyata, S., Sugimura, K., Sato, K., Nakano, M., Shiroto, T., Tsuburaya, R., Nochioka, K., Yamamoto, H., Aoki, T., Hao, K., Miura, M., Kondo, M., Tatebe, S., Yamamoto, S., Suzuki, H., Nishimiya, K., Yaoita, N., Yamamoto, Y., Toda, S., Minatoya, Y., Takagi, Y., Hasebe, Y., Nihei, T., Hanawa, K., Tadaki, S., Ushigome, R., Yamauchi, T., Tsuji, K., Onose, T., Abe, R., Saga, C., Suenaga, J., Yamada, Y., Kimura, J., Ogino, H., Oikawa, I., Watanabe, S., Saga, M., Washio, M., Nagasawa, K., Nagasawa, S., Kotaka, S., Komatsu, W., Hashimoto, R., Ikeno, Y., Suzuki, T., and Hamada, H.
- Subjects
Male ,medicine.medical_specialty ,Adrenergic beta-Antagonists ,Tetrazoles ,Angiotensin-Converting Enzyme Inhibitors ,Blood Pressure ,Kaplan-Meier Estimate ,Medication Adherence ,Clinical Research ,Internal medicine ,medicine ,Clinical endpoint ,Olmesartan ,Humans ,Prospective Studies ,Myocardial infarction ,Prospective cohort study ,Stroke ,Aged ,Heart Failure ,business.industry ,Hazard ratio ,Imidazoles ,Heart Failure/Cardiomyopathy ,medicine.disease ,Treatment Outcome ,Endocrinology ,Blood pressure ,Heart failure ,Chronic Disease ,Hypertension ,Angiotensin II receptor blocker ,Cardiology ,Drug Therapy, Combination ,Female ,Cardiology and Cardiovascular Medicine ,business ,Angiotensin II Type 1 Receptor Blockers ,medicine.drug - Abstract
We examined whether an additive treatment with an angiotensin receptor blocker, olmesartan, reduces the mortality and morbidity in hypertensive patients with chronic heart failure (CHF) treated with angiotensin-converting enzyme (ACE) inhibitors, β-blockers, or both. In this prospective, randomized, open-label, blinded endpoint study, a total of 1147 hypertensive patients with symptomatic CHF (mean age 66 years, 75% male) were randomized to the addition of olmesartan (n = 578) to baseline therapy vs. control (n = 569). The primary endpoint was a composite of all-cause death, non-fatal acute myocardial infarction, non-fatal stroke, and hospitalization for worsening heart failure. During a median follow-up of 4.4 years, the primary endpoint occurred in 192 patients (33.2%) in the olmesartan group and in 166 patients (29.2%) in the control group [hazard ratio (HR) 1.18; 95% confidence interval (CI), 0.96–1.46, P = 0.112], while renal dysfunction developed more frequently in the olmesartan group (16.8 vs. 10.7%, HR 1.64; 95% CI 1.19–2.26, P = 0.003). Subgroup analysis revealed that addition of olmesartan to combination of ACE inhibitors and β-blockers was associated with increased incidence of the primary endpoint (38.1 vs. 28.2%, HR 1.47; 95% CI 1.11–1.95, P = 0.006), all-cause death (19.4 vs. 13.5%, HR 1.50; 95% CI 1.01–2.23, P = 0.046), and renal dysfunction (21.1 vs. 12.5%, HR 1.85; 95% CI 1.24–2.76, P = 0.003). Additive use of olmesartan did not improve clinical outcomes but worsened renal function in hypertensive CHF patients treated with evidence-based medications. Particularly, the triple combination therapy with olmesartan, ACE inhibitors and β-blockers was associated with increased adverse cardiac events. This study is registered at clinicaltrials.gov-NCT00417222.
- Published
- 2015