When compared to other ARB’s, telmisartan and valsartan are both shown to significantly reduce the risk of hospital admission for stroke, myocardial infarctions, and heart failure by up to 15%….
Telmisartan, valsartan, and irbesartan belong to a class of medications known as angiotensin-receptor blockers or ARBs.
Other ARB medications such as losartan and candesartan do not have the same effects on cardiovascular health as telmisartan and valsartan. Dr. Tony Antoniou of St. Michael’s Hospital in Toronto, ON says, "Our findings suggest that statistically important differences exist in the effectiveness of angiotensin-receptor blockers when used for the prevention of diabetes related macrovascular disease and that a class effect for these agents may not be assumed when used for this purpose in clinical practice."
The population-based retrospective study included an analysis of 54,186 Canadian patients with diabetes who started taking an ARB between 2001 and 2011. All patients were 66 years of age or older, the average age being 73 years, and the average duration of diabetes was approximately six years. Overall, 20.2% of patients were treated with candesartan, 23.4% with irbesartan, 15.5% with losartan, 15.1% with telmisartan, and 25.8% with valsartan.
The primary end point, a composite of admission to the hospital for MI, heart failure, or stroke, occurred in 2,712 patients taking an ARB. In an adjusted risk model, telmisartan was associated with a 15% lower risk of the primary end point, while valsartan was associated with a 14% lower risk, when compared with irbesartan. In a dose-response analysis, the group found no difference in the risk of the primary outcome with moderate or high doses of ARBs, although the effectiveness of valsartan was "somewhat attenuated" when adjusted for dose.
The reason that telmisartan and valsartan can be used versus other ARBs is due to the fact that these drugs possess special properties that differentiate them from other the drugs in their class. They are partial agonists of peroxisome proliferator activated receptor which is responsible for regulating lipid metabolism and insulin sensitivity.
These findings are important because it shows us that just because drugs belong to the same class of medications doesn’t mean that they have the same benefits and effects.
O’Riordan Michael. published online July 8, 2013 in CMAJ.