title: Angiotensin-converting enzyme inhibitors reduce albuminuria more than angiotensin receptor blockers in patients with type 2 diabetes.
abstract: OBJECTIVE
  This study retrospectively compared the effects of angiotensin-converting enzyme inhibitors (ACEIs) versus angiotensin receptor blockers (ARBs) as classes with respect to overall mortality and cardiovascular and renal events in patients with type 2 diabetes.
  
  
  METHODS
  An electronic database of medical records was reviewed. A total of 16,489 patients with type 2 diabetes were enrolled and divided into ACEI (n = 12,351) or ARB (n = 4,138) groups. Baseline patient characteristics were compared using univariable analysis. A chi-square test was used for categorical outcomes, and the propensity class was calculated using multivariable logistic regression. Survival analysis was performed to evaluate the effect of ACEIs/ARBs on overall survival, coronary artery disease (CAD), and renal events via Cox regression analysis, adjusting for propensity class and baseline variables. All statistical analyses were conducted using R 2.15.1 software.
  
  
  RESULTS
  No significant differences in overall survival (P = .16) and CAD (P = .81) events were observed between groups. With respect to renal events, ARBs increased the risk of creatinine doubling compared with ACEIs, but the difference was not significant (hazard ratio [HR], 1.207; 95% confidence interval [CI], 0.921-1.583; P = .173). Patients who received ARBs had a significantly higher rate of albuminuria than patients who received ACEIs (HR, 1.303; 95% CI, 1.053-1.612; P = .015).
  
  
  CONCLUSIONS
  The early effects of ACEIs and ARBs on albuminuria outcome seem to be different in type 2 diabetes, favoring the use of ACEIs. A well-designed prospective study is warranted to evaluate this finding.
authors: Department of Endocrinology and Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. n_alsayed@hotmail.com
authors: Nasreen A
authors: NA
authors: Al-Sayed
authors: Tianming
authors: T
authors: Gao
authors: Brian J
authors: BJ
authors: Wells
authors: Changhong
authors: C
authors: Yu
authors: Robert S
authors: RS
authors: Zimmerman
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000188:drug therapy*; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors