In hypertensive chronic heart failure (CHF) patients receiving evidence-based treatment, the addition of olmesartan therapy failed to improve clinical regression and instead worsened renal function, especially when the combination of olmesartan, renin angiotensin-converting enzyme inhibitor (ACEI) and beta-blocker was associated with increased adverse cardiac events, a Japanese study showed. The paper was published online Jan. 31 in the European Heart Journal (Eur Heart J). This prospective, randomized, open-label study enrolled 1147 hypertensive patients with symptomatic CHF and randomized to add olmesartan (578 patients) or maintenance of the original treatment (569 patients) to baseline therapy. The primary endpoint consisted of all-cause death, nonfatal heart attack, nonfatal stroke, and hospitalization for heart failure exacerbation. The median follow-up time was 4.4 years. The mean age of patients was 66 years and 75% were male. Results showed that the primary endpoint occurred in 192 (33.2%) and 166 (29.2%) cases in the olmesartan and control groups, respectively (hazard ratio [HR] 1.18; P=0.112), and that the incidence of renal insufficiency was higher in the olmesartan group (16.8% versus 10.7%, HR 1.64; P=0.003). Subgroup analysis showed that the addition of olmesartan to ACEI and beta blockers was associated with an increased incidence of the primary endpoint (38.1% versus 28.2%, HR 1.47), all-cause death (19.4% versus 13.5%, HR 1.50), and renal insufficiency (21.1% versus 12.5%, HR 1.85).