MEC Talk : Organ Donation by Dr Syed Faisal (24.3.2011)

Olmesartan Delays Microalbuminuria in Diabetes, But With Risks

Olmesartan, an angiotensin-receptor blocker, delays the development of microalbuminuria in patients with type 2 diabetes and well-controlled blood pressure, but its use is associated with an increased risk of death from cardiovascular events, according to a New England Journal of Medicine study.

The ROADMAP trial, sponsored by the drug's manufacturer, randomized some 4500 diabetic patients with normoalbuminuria to daily olmesartan or placebo. In addition, participants' blood pressures were treated to maintain values under 130/80 mm Hg.

After a median 3-year follow-up, the olmesartan group showed a significant advantage over placebo in delaying time to onset of microalbuminuria (the primary outcome). However, fatal cardiovascular events were more common with olmesartan.

An editorialist writes that the finding of delayed microalbuminuria was not unanticipated.

And given the increased cardiovascular mortality found with olmesartan, she asks why wouldn't other renin-angiotensin blocking drugs be prescribed if they are not associated with fatal complications?

Comment: (Or would others also cause similar fatal complications?)

NEJM article (Free abstract)

NEJM editorial (Subscription required)