title: 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.
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.
authors: Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
authors: Yasuhiko
authors: Y
authors: Sakata
authors: Department of Cardiovascular Medicine, International University of Health and Welfare Hospital, Nasushiobara, Japan.
authors: Nobuyuki
authors: N
authors: Shiba
authors: Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
authors: Jun
authors: J
authors: Takahashi
authors: Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
authors: Satoshi
authors: S
authors: Miyata
authors: Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
authors: Kotaro
authors: K
authors: Nochioka
authors: Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
authors: Masanobu
authors: M
authors: Miura
authors: Department of Cardiovascular Medicine, International University of Health and Welfare Hospital, Nasushiobara, Japan.
authors: Tsuyoshi
authors: T
authors: Takada
authors: Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
authors: Chiharu
authors: C
authors: Saga
authors: Cardiovascular Division, Sendai Medical Center, National Hospital Organization, Sendai, Japan.
authors: Tsuyoshi
authors: T
authors: Shinozaki
authors: Cardiovascular Division, Iwaki Kyouritsu Hospital, Iwaki, Japan.
authors: Masafumi
authors: M
authors: Sugi
authors: Department of Cardiology, Iwate Prefectural Isawa Hospital, Oshu, Japan.
authors: Makoto
authors: M
authors: Nakagawa
authors: Cardiovascular Division, Hiraka General Hospital, Yokote, Japan.
authors: Nobuyo
authors: N
authors: Sekiguchi
authors: Department of Cardiology, Miyagi Cardiovascular and Respiratory Center, Kurihara, Japan.
authors: Tatsuya
authors: T
authors: Komaru
authors: Cardiovascular Division, Sendai Open Hospital, Sendai, Japan.
authors: Atsushi
authors: A
authors: Kato
authors: Cardiovascular Division, Sendai Tokushukai Hospital, Sendai, Japan.
authors: Mitsumasa
authors: M
authors: Fukuchi
authors: Department of Cardiology, Iwate Prefectural Central Hospital, Morioka, Japan.
authors: Eiji
authors: E
authors: Nozaki
authors: Cardiovascular Division, Osaki Citizen Hospital, Osaki, Japan.
authors: Tetsuya
authors: T
authors: Hiramoto
authors: Cardiovascular Division, South Miyagi Medical Center, Ogawara, Japan.
authors: Kanichi
authors: K
authors: Inoue
authors: Department of Cardiology, Yamagata Prefectural Central Hospital, Yamagata, Japan.
authors: Toshikazu
authors: T
authors: Goto
authors: Cardiovascular Division, Kojirakawa Shiseido Hospital, Yamagata, Japan.
authors: Masatoshi
authors: M
authors: Ohe
authors: Department of Cardiology, Iwate Prefectural Miyako Hospital, Miyako, Japan.
authors: Kenji
authors: K
authors: Tamaki
authors: Seiai Rehabilitation Hospital, Onojo, Japan.
authors: Setsuro
authors: S
authors: Ibayashi
authors: Sendai Shirayuri Women's College, Sendai, Japan.
authors: Nobumasa
authors: N
authors: Ishide
authors: Hoshi General Hospital, Koriyama, Japan.
authors: Yukio
authors: Y
authors: Maruyama
authors: Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Ichiro
authors: I
authors: Tsuji
authors: Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan shimo@cardio.med.tohoku.ac.jp.
authors: Hiroaki
authors: H
authors: Shimokawa
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D007093:Imidazoles / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D055118:Medication Adherence; D011446:Prospective Studies; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D007093:Imidazoles; D013777:Tetrazoles; C437965:olmesartan
keywords: Angiotensin II receptor blocker; Heart failure; Hypertension; Olmesartan
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