ACE inhibitors are associated with a reduction in all-cause mortality versus angiotensin II receptor blockers in patients with diabetes mellitus

Commentary on: Cheng J, Zhang W, Zhang X, et al.. Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on all-cause mortality, cardiovascular deaths, and cardiovascular events in patients with diabetes mellitus: a meta-analysis. JAMA Intern Med 2014;174:773–85. Context Renin-angiotensin system blockade has been proven to reduce mortality and morbidity in populations at high risk for cardiovascular events. This extends to the patients with diabetes mellitus, where evidence-based guidelines recommend first -line treatment with ACE inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) in patients with hypertension and/or proteinuria.1 However, few studies have directly compared ACEIs to ARBs in a randomised-controlled trial (RCT) design. Since ACEIs and ARBs antagonise the renin-angiotensin system through different mechanisms, it is possible that their effects on mortality and cardiovascular outcomes may not be identical. Methods This was a meta-analysis of RCTs that compared different ACEI and...
Source: Evidence-Based Medicine - Category: Internal Medicine Authors: Tags: Epidemiologic studies, Immunology (including allergy), Drugs: cardiovascular system, Drugs: CNS (not psychiatric), Stroke, Hypertension, Ischaemic heart disease, Diabetes, Guidelines Therapeutics Source Type: research