The angiotensin-receptor blockers telmisartan and valsartan might help prevent major cardiovascular events better than other ARBs in patients with diabetes, according to a CMAJ study.

Using Canadian databases, researchers identified 54,000 older adults with diabetes who were first-time users of ARBs. After multivariable adjustment, both telmisartan and valsartan were associated with about a 15% reduction in risk for hospital admission for acute myocardial infarction, heart failure, or stroke, compared with irbesartan. The risk was not significantly reduced for candesartan or losartan.

The authors conclude that “a class effect may not be assumed when using angiotensin-receptor blockers for the prevention of diabetes-related macrovascular complications or heart failure, and that telmisartan and valsartan may be the preferred drugs for this indication.” Meanwhile, a commentator concludes, “without appropriately designed randomized controlled trials, there is scant evidence to support preferring one drug in this class over another for patients with type 2 diabetes.”

Source: CMAJ