1. ¹Policy Analysis Inc. (PAI), Brookline, MA, USA
2. ²Novartis Pharma AG, Basel, Switzerland
3. ³Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
4. ⁴Department of Cardiology, Ullevaal University Hospital, Oslo, Norway
5. ⁵Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA

Correspondence: Dr D Weycker, Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA 02445, USA. E-mail: dweycker@pai2.com

Received 26 September 2006; Revised 27 December 2006; Accepted 28 December 2006; Published online 22 February 2007.

Abstract

In the Valsartan Antihypertensive Long-Term Use Evaluation (VALUE) trial, the risk of new-onset diabetes was reported to be 23% lower among patients initiating therapy with valsartan versus amlodipine. The objective of our study was to examine whether this finding is generalizable to 'real-world' clinical practice. A retrospective cohort design and a large US health insurance database were employed for analyses. Study subjects included all hypertensive patients, aged 35 years, who were free from diabetes and who initiated treatment with valsartan (n=9999) or amlodipine (n=18 698) between January 1999 and March 2005. Unadjusted absolute risks of diabetes were 21.4 (95% confidence interval (CI) 18.9–24.3) and 26.3 (95% CI 24.3–28.3) per 1000 patient-years for valsartan and amlodipine, respectively; the corresponding relative risk (RR) for valsartan was 0.82 (95% CI 0.70–0.94). Multivariate analyses – controlling for age, sex, presence of hypercholesterolemia, cardiovascular disease and kidney disease, and pretreatment medical care expenditures – yielded similar results (RR=0.79, 95% CI 0.68–0.92). Our study thus corroborates the finding from VALUE that diabetes risk is lower for patients who receive valsartan versus amlodipine, and extends this finding to a 'real-world' setting.