Olmesartan, one of the most widely used angiotension II receptor blocker (ARB) to treat hypertension, is reported to have association with sprue-like enteropathy, recently. Olmesartan-associated enteropathy has not been described in Northeast Asia until now. We examine the association between incident enteropathy and use of olmesartan or other ARBs in Korea.Design and Method:
From the prospective cohort data from Korean National Health Insurance Service, we studied 114,429 patients (55,370 women) who initiated ACE inhibitor (ACEi), olmesartan or other ARBs from January 2005 and 31 December 2012 without history of intestinal malabsorption preceding 1 year. Incidence of diagnosis for intestinal malabsorption was compared between medication groups. In post-hoc analysis, the change of body weight was also compared after propensity score matching group of ACEi and olmesartan with available results of medical examination.Results:
During total of 313,369 person-years (PY), 46 patients were diagnosed for enteropathy. The incidence rates of enteropathy were 4.28, 0.87, and 1.42 per 10,000 PY, in ACEi, olmesartan and other ARB group, respectively. Adjusted rate ratios for enteropathy were 0.69 (95% CI 0.40–1.19, P = 0.183) in olmesartan group and 0.59 (95% CI 0.27–1.27, P = 0.175) in other ARB group compared with ACEi group after adjustment for heart failure, dementia, diabetes, autoimmune diseases, transplantation, ongoing cancer and end-stage renal failure. In post-hoc analysis with matched cohort, body weight was decreased more in ACEi group than in olmesartan group (−0.1 kg/year vs. 0.0 kg/year, respectively; P = 0.010). The proportion of patients with significant weight loss was not different between ACEi and olmesartan group (3.3% vs. 3.5%, respectively; P = 0.911).Conclusions:
There is no robust signal for incident intestinal malabsorption with olmesartan use among Korean general population. Further prospective, larger-scale studies aimed at investigating the exact role of olmesartan on incident enteropathy and its ethnic differences are needed.