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ROADMAP and ORIENTAL Trials: the Re-emergence of J-Curve Ghost?

Yoshiyuki Hamamoto1, Hiroyuki Koshiyama

  • 1Center for Diabetes and Endocrinology, The Tazuke Kofukai Foundation Medical Institute Kitano Hospital, Osaka, Japan.

Japanese Clinical Medicine
|July 26, 2013
PubMed

Insights

The cardioprotective effects of angiotensin-receptor blockers (ARBs) in type 2 diabetes patients remain unclear. Some trials suggest higher cardiovascular risks with aggressive blood pressure lowering, possibly indicating a J-curve phenomenon in high-risk individuals.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Cardioprotection by angiotensin-receptor blockers (ARBs) in type 2 diabetes is not well-established.
  • Type 2 diabetes is a significant risk factor for cardiovascular disease.

Purpose of the Study:

  • To investigate the cardioprotective potential of ARBs in patients with type 2 diabetes.
  • To analyze cardiovascular event rates in ARB treatment groups.

Main Methods:

  • Review of recent clinical trials, specifically the ROADMAP and ORIENT studies.
  • Analysis of cardiovascular outcomes, including fatal events and deaths, in patients treated with olmesartan.

Main Results:

  • Unexpectedly higher rates of fatal cardiovascular events and cardiovascular deaths were observed in the olmesartan group.
  • These findings suggest a potential increased risk associated with aggressive blood pressure lowering in certain patient subgroups.

Conclusions:

  • Aggressive blood pressure lowering with ARBs may increase cardiovascular risk in high-risk patients, particularly those with coronary heart disease.
  • The J-curve phenomenon, where very low blood pressure is associated with increased risk, may be relevant in this population.
Keywords:
J-curveORIENTROADMAPangiotensin-receptor blockersolmesartan

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