Long-term outcomes associated with continued use of ARBs versus CCBs in older adults: a landmark cohort study

Evidence guiding treatment selection for patients already receiving long-term antihypertensive therapy remains uncertain, particularly in older adults. We compared long-term outcomes associated with continued use of angiotensin receptor blockers (ARBs) versus calcium channel blockers (CCBs) among older adults receiving sustained antihypertensive therapy. Using linked administrative claims and health examination data from Japan, we conducted a retrospective cohort study of individuals aged ≥65 years who had continuously received either ARBs or CCBs for at least 12 months, with this time point defined as the landmark for follow-up. Discrete-time proportional hazards models with inverse probability of treatment and censoring weights were used to account for confounding and informative censoring. A total of 59,558 individuals (20,028 ARB users and 39,530 CCB users) were included, with a median follow-up of 4.75 years. Sustained ARB use was associated with a lower risk of heart failure hospitalization (hazard ratio [HR] 0.817, 95% confidence interval [CI] 0.758-0.882) and end-stage renal disease (HR 0.162, 95% CI 0.089-0.295). Risks of myocardial infarction and major adverse cardiovascular events were similar between groups, and stroke risk did not differ meaningfully. Blood pressure levels were comparable throughout follow-up. Among older adults receiving long-term antihypertensive therapy, continued use of ARBs was associated with lower risks of heart failure hospitalization and ESRD/dialysis compared with CCBs, despite similar blood pressure control. These findings may inform treatment selection in patients already established on antihypertensive therapy.