Supplemental Benefit of an ARB in Hypertensive Patients With Stable Heart Failure Using Olmesartan | Clinical Trial - SUPPORT
The goal of the trial was to evaluate treatment with olmesartan compared with control among hypertensive patients with chronic heart failure (CHF) on a background therapy of angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, or both.
Contribution to the Literature: The SUPPORT trial showed that the addition of olmesartan to standard heart failure therapy (ACE inhibitors and beta-blockers) increased adverse events.
Patients with hypertension and CHF on optimal medical therapy were randomized to olmesartan (n = 578) versus control (n = 569). Olmesartan was started at 5-10 mg daily and titrated to 40 mg daily.
- Total number of enrollees: 1,147
- Duration of follow-up: Median 4.4 years
- Mean patient age: 66 years
- Percentage female: 25%
- Percentage diabetics: 49%
- Mean left ventricular ejection fraction (LVEF) = 55%
- Hypertensive patients 20-79 years of age with chronic stable heart failure (New York Heart Association class II-IV symptoms)
- Treatment with ACE inhibitors and/or beta-blockers
- Renal or liver dysfunction
- History of angioedema
- Life-threatening illness
- Cardiovascular surgery, myocardial infarction (MI), or percutaneous coronary intervention within the previous 6 months
The primary outcome, all-cause death, MI, stroke, or hospitalization for heart failure occurred in 33.2% of the olmesartan group versus 29.2% of the control group (p = 0.006).
- All-cause death: 19.4% vs. 13.5% (p = 0.046), respectively
- Renal dysfunction: 21.1% vs. 12.5% (p = 0.003), respectively
Among patients with hypertension and CHF on standard medical therapy, the addition of olmesartan was not beneficial. In fact, addition of olmesartan was associated with an increase in all-cause mortality and renal dysfunction. The mean LVEF was 55%; therefore, the findings mainly apply to patients with heart failure with preserved ejection fraction. Several lines of evidence have revealed a harmful effect of adding an angiotensin-receptor blocker to an ACE inhibitor.
Sakata Y, Shiba N, Takahashi J, et al. Clinical impacts of additive use of olmesartan in hypertensive patients with chronic heart failure: the supplemental benefit of an angiotension receptor blocker in hypertensive patients with stable heart failure using olmesartan. Eur Heart J 2015;Jan 31:[Epub ahead of print].M
Keywords: Heart Failure, Angiotensin-Converting Enzyme Inhibitors, Hypertension, Hospitalization, Stroke, Adrenergic beta-Antagonists, Secondary Prevention, Control Groups
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