by Colin Kenny, GP, Dromore
Clinical trial data in people with hypertension alone have previously called into question the cardioprotective effects of renin–angiotensin–aldosterone system blockade. Therefore, the authors of this study examined the available medical literature and conducted a meta-analysis that examined the effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on major cardiovascular (CV) events and death, as well as death from all other causes. Head-to-head studies are limited, so they evaluated the effect of ACE inhibitors and ARBs separately, versus placebo or other medications, on the incidence of all-cause mortality, CV deaths and CV events in people with diabetes.
The authors identified 35 clinical trials: 23 compared ACE inhibitors with placebo or other active drugs (n=32,827) and 13 other trials compared ARBs with no therapy (controls; n=23,867). An analysis of the clinical trials suggests that ACE inhibitors reduce the risk of death from all causes by 13%, cut the risk of CV deaths by 17% and lower the risk of major CV events by 14%. ARBs did not affect all-cause mortality. ACE inhibitors and ARBs were not associated with a decreased risk of stroke in people with diabetes. The authors suggest that ACE inhibitors should be considered as first-line therapy to limit the excess mortality and morbidity in this population.
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