[Beta blockers or ACE inhibitors following myocardial infarction in patients with diabetes?].
BACKGROUND
Total mortality after myocardial infarction is about twice as high for diabetic as for non-diabetic subjects. ACE inhibitors are regarded as a first drug for all diabetics, also for post-infarction treatment.


METHODS
We have reviewed the literature with an emphasis on the effect on hard end points in diabetic subjects treated for at least six weeks with beta blockers or ACE inhibitors after myocardial infarction.


RESULTS
We identified eight post-infarction studies for which subgroup analyses of diabetic subjects were available, four with beta blockers and four with ACE inhibitors. We found that beta blockers without intrinsic sympathetic activity probably reduce total mortality more than ACE inhibitors do. The reduction of total mortality after treatment with beta blockers was 56-63%, compared to 12-35% after treatment with ACE inhibitors.


CONCLUSIONS
Beta blockers should be the preferred choice in post-infarction treatment of diabetics. ACE inhibitors and beta blockers used together give no further reduction in mortality.
Gystad
K
K
Det medisinske fakultet, Norges teknisk-naturvitenskapelige universitet, Trondheim.
Carlsen
S M
SM
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D004311:Double-Blind Method; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D011379:Prognosis; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors