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

Yasuhiko Sakata, Nobuyuki Shiba, Jun Takahashi, Satoshi Miyata, Kotaro Nochioka, Masanobu Miura, Tsuyoshi Takada, Chiharu Saga, Tsuyoshi Shinozaki, Masafumi Sugi, Makoto Nakagawa, Nobuyo Sekiguchi, Tatsuya Komaru, Atsushi Kato, Mitsumasa Fukuchi, Eiji Nozaki, Tetsuya Hiramoto, Kanichi Inoue, Toshikazu Goto, Masatoshi OheKenji Tamaki, Setsuro Ibayashi, Nobumasa Ishide, Yukio Maruyama, Ichiro Tsuji, Hiroaki Shimokawa

Research output: Contribution to journalArticlepeer-review

38 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)915-923
Number of pages9
JournalEuropean Heart Journal
Volume36
Issue number15
DOIs
Publication statusPublished - 2015 Apr 14

Keywords

  • Angiotensin II receptor blocker
  • Heart failure
  • Hypertension
  • Olmesartan

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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