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RAS blocker benefits similar to those of other antihypertensive drug classes in diabetes
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No superiority was found for renin-angiotensin system blockers over other antihypertensive drug classes, including thiazides, calcium channel blockers and beta-blockers, in diabetes for reducing the risk for cardiovascular and renal endpoints.
“In patients with diabetes but without renal disease, any of the currently used antihypertensive agents provide similar cardiovascular protection,” Sripal Bangalore, MD, associate professor in the department of medicine at New York University School of Medicine, told Endocrine Today.
Sripal Bangalore
Bangalore and colleagues conducted a meta-analysis of 19 randomized controlled trials to determine outcomes for use of renin-angiotensin system (RAS) blockers compared with other antihypertensive drugs in people with diabetes.
RAS blockers yielded similar risks as other antihypertensive drugs for death (RR = 0.99; 95% CI, 0.93-1.05), CV death (RR = 1.02; 95% CI, 0.83-1.24), MI (RR = 0.87; 95% CI, 0.64-1.18), angina pectoris (RR = 0.8; 95% CI, 0.58-1.11), stroke (RR = 1.04; 95% CI, 0.92-1.17), heart failure (RR = 0.9; 95% CI, 0.76-1.07) and revascularization (RR = 0.97; 95% CI, 0.77-1.22). Major adverse CV events (RR = 0.97; 95% CI, 0.89-1.06), ESRD (RR = 0.99; 95% CI, 0.78-1.28) or drug withdrawal due to adverse events did not differ between the two groups.
“Early placebo-controlled trials ... have shown significant benefits from use of [RAS] blockers on [CV] and renal endpoints in people with diabetes, benefits touted to be independent of the drugs’ blood pressure-lowering efficacy,” the researchers wrote.
“This analysis of head-to-head comparison trials of RAS blockers vs. other antihypertensive agents in people with diabetes (and largely without microalbuminuria or proteinuria) failed to show a superiority of RAS blockers compared with other antihypertensive agents for the prevention of hard outcomes. The results support the recommendation of both the 2013 European Society of Cardiology/European Society of Hypertension guidelines and the 2014 eighth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure that any class of antihypertensive agents can be used in people with diabetes, especially in those without renal impairment.” – by Amber Cox
For more information:
Sripal Bangalore, MD, can be reached at sripalbangalore@gmail.com.
Disclosure: Bangalore reports various financial ties with Accor, Boehringer Ingelheim, Daiichi, Gilead, Merck, Pfizer and Sankyo. Please see the full study for a list of all other authors’ relevant financial disclosures.
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