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ACE inhibitors viable first-line therapy in diabetes
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Recently published data showed that ACE inhibitors may produce better outcomes in patients with diabetes than other antihypertensive medications.
Researchers performed a systematic review and meta-analysis of 63 randomized clinical trials reporting all-cause mortality, dialysis requirement and serum creatinine levels in 36,917 patients with diabetes who received antihypertensive therapies. Evaluated treatments included ACE inhibitors, angiotensin receptor blockers, alpha- and beta-blockers, calcium-channel blockers and diuretics, alone or in combination.
There were 2,400 deaths across 62 studies, 766 patients with end-stage renal disease across 19 studies and 1,099 patients who experienced doubling in serum creatinine across 13 studies. Findings indicated that ACE inhibitors significantly decreased creatinine doubling compared with placebo (OR=0.58; 95% credible interval, 0.32-0.9), and beta-blockers significantly increased mortality risk (OR=7.13; 95% credible interval, 1.37-41.39). No treatments had a significant effect on risk for end-stage renal disease.
Combination therapy with ACE inhibitors and calcium-channel blockers did not have a statistically significant protective effect compared with placebo, but the treatment had the highest probability (73.9%) of reducing mortality, followed by an ACE inhibitor administered with a diuretic (12.5%), ACE inhibitors alone (2%), calcium-channel blockers (1.2%) and angiotensin receptor blockers (0.4%). In contrast, beta-blockers had the highest probability of being least effective (69.4%).
Similarly, ACE inhibitors were most likely to be ranked highest (29.6%) or second-highest (37.5%) for the reduction of end-stage renal disease incidence, and were most likely to be the best therapy for reducing incidence of serum creatinine doubling (79.5%).
“Our analyses show the renoprotective effects and superiority of using ACE inhibitors in patients with diabetes, and also show the harmful effects of beta-blockers,” the researchers wrote. “Considering the cost of drugs, our findings support the use of ACE inhibitors as the first-line antihypertensive agent in patients with diabetes. Calcium channel blockers might be the preferred treatment in combination with ACE inhibitors if adequate blood pressure control cannot be achieved by ACE inhibitors alone.”
Disclosure: The researchers report no relevant financial disclosures.
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