ACE inhibitors and calcium channel blockers: patterns of use and associations with mortality in type 1 diabetes.
OBJECTIVE
To determine the frequency of ACE-I and Calcium channel blockers (CCB) use in type 1 diabetes (T1D), and associations of these medications with mortality.


METHODS
Data from the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study, a 10-year follow up of childhood onset T1D, were used to document ACE-I and CCB use. Use in subjects who died during follow up was compared to gender, age, duration (+/-5 years), hypertension, and renal status matched living controls.


RESULTS
ACE-I use increased from baseline (1986-1988) to 10 years later (1996-1998) for those with hypertension (20.8-65.8%), and microalbuminuria (2.3-31.5%). However, the majority of patients with microalbuminuria were not on ACE-I at 10 years. CCB use was 2.1% at baseline, increased to 10.4% at 8 years, and fell to 9.5% at 10 years. An increased risk of mortality was apparent for those not treated with either ACE-I or CCB when controlling for cardiovascular status and age (hazard ratio (HR) 2.6, 95% CI 1.1-6.3), while ACE-I use alone was protective (HR=0.26, 0.08-0.79). CCB use with or without ACE-I was not related to mortality status.


CONCLUSIONS
This data suggests that ACE-I use is not optimal, but more favorably associated with decreased mortality than CCB use.
Sobolewski
Brad A
BA
University of Pittsburgh School of Medicine, 3512 5th Avenue, Pittsburgh, PA 15213, USA.
Zgibor
Janice C
JC
Orchard
Trevor J
TJ
D000328:Adult; D000419:Albuminuria / Q000188:drug therapy; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000494:pharmacology* / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000401:mortality; D003928:Diabetic Nephropathies / Q000401:mortality / Q000517:prevention & control; D004358:Drug Therapy / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers