title: Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and diabetes: a meta-analysis of placebo-controlled clinical trials.
abstract: BACKGROUND
  To determine whether the administration of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) on top of standard cardiovascular (CV) therapies may reduce the incidence of new onset diabetes (NOD) in placebo-controlled clinical trials. The effects of these drugs on CV and non-CV mortality were also tested.
  
  
  METHODS
  We performed a meta-analysis of all randomized clinical trials (11 trials, n = 84,363 patients, aged 64.2 ± 5.86 years), published until 14 March 2010, in which ACE inhibitors or ARBs were compared with placebo and NOD incidence, CV, and non-CV mortality were reported.
  
  
  RESULTS
  Over an average follow-up of 4.0 ± 1.0 years, there were 1,284/15,142 (8.5%) cases of NOD in active-treated and 1,411/15,130 (9.3%) cases in placebo-treated patients in the ACE inhibitor trials, and 2,330/18,756 (12.4%) cases in active-treated and 2,669/18,800 (14.2%) cases in placebo-treated patients in the ARB trials. Overall, active therapy reduced NOD compared to placebo (odds ratio (OR) 95%, confidence interval (CI): 0.8 (0.8-0.9); P < 0.01). Both ACE inhibitors (OR 95%, CI: 0.8 (0.7-1.0); P = 0.07) and ARBs (OR 95%, CI: 0.8 (0.8-0.9); P < 0.01) reduced NOD as compared to placebo. Active treatment reduced CV mortality (OR 95%, CI: 0.9 (0.8-1.0); P < 0.01) and had a favorable impact on non-CV mortality (OR 95%, CI: 0.7 (0.9-1.0); P = 0.2) as compared to placebo.
  
  
  CONCLUSIONS
  Our findings demonstrated that ACE inhibitors or ARBs should be preferred in patients with clinical conditions that may increase risk of NOD, since these drugs reduced NOD incidence. In addition, these drugs have favorable effects on CV and non-CV mortality in high CV risk patients.
authors.affiliation: Division of Cardiology, Department of Clinical and Molecular Medicine, II Faculty of Medicine, University of Rome "La Sapienza", Sant'Andrea Hospital, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Tocci
authors.forename: Francesco
authors.initials: F
authors.lastname: Paneni
authors.forename: Francesca
authors.initials: F
authors.lastname: Palano
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Sciarretta
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferrucci
authors.forename: Theodore
authors.initials: T
authors.lastname: Kurtz
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Massimo
authors.initials: M
authors.lastname: Volpe
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000401:mortality; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors