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Meta-Analysis Finds ACE Inhibitors Superior in Patients with Diabetes — Physician’s First Watch

Medical News |
October 28, 2013

Meta-Analysis Finds ACE Inhibitors Superior in Patients with Diabetes

By Amy Orciari Herman

Angiotensin-converting-enzyme (ACE) inhibitors are the antihypertensive treatment of choice in adults with diabetes, according to a BMJ meta-analysis.

Researchers examined nearly 70 randomized trials evaluating 11 antihypertensive regimens in roughly 37,000 adults with diabetes. Outcomes included all-cause mortality, end-stage renal disease, and doubling of serum creatinine.

Among the findings:

  • Combination therapy with ACE inhibitors plus calcium-channel blockers appeared most likely to reduce all-cause mortality; beta-blockers showed a significant increase in mortality.

  • Only ACE inhibitors significantly prevented the doubling of serum creatinine, compared with placebo.

  • Outcomes did not differ significantly between ACE inhibitors and angiotensin-receptor blockers, but ACE inhibitors "consistently showed higher probabilities of being at the superior ranking positions among all outcomes," the authors write.

The authors conclude that ACE inhibitors should be first-line antihypertensive therapy in adults with diabetes, noting that calcium-channel blockers might be added when blood pressure cannot be controlled with ACE inhibitors alone.

Reader Comments (3)

Donna Roberson Rph Other Healthcare Professional, Pharmacology/Pharmacy, Walgreens

I am researching the affect of ACE inhibitors on renal function of diabetic patients

Adam Clements DO Resident, Family Medicine/General Practice, Wisconsin

Most of the data i've used has discouraged using ace inhibitors as first line in black patients due to poorer response from ace inhibitors and better results from other drugs. Would be nice to know how this study fits in. Should i start using them again in black patients as first line? I couldn't figure that out from reading this article.

dhan acharya, MD

Thanks for the update. Would like to know if it was true for both type 1 and 2 DM

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