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

It still remains unknown whether angiotensin-receptor blockers (ARBs) are cardioprotective in patients with type 2 diabetes. The recent two clinical trials, the ROADMAP and the ORIENT, have suggested that fatal cardiovascular events or cardiovascular deaths were unexpectedly higher in olmesartan group. These results suggest that aggressive blood pressure lowering may cause a higher risk in some high-risk patients, especially in those with preexisting coronary heart disease, indicating a possibility that the J-curve phenomenon may exist in some group of patients.