The Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers in Patients With Diabetes.
The evidence examining the effect of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) on mortality in high-risk patients is conflicting. To further examine this controversy, the authors compared outcomes between ACE inhibitors and ARBs in a large clinical diabetes registry. A retrospective cohort of 87,472 incident users followed for 105,702 patient-years was analyzed. Average age was 53.1±10.1 years, 54.2% were men, and 14.4% had cardiovascular disease. All-cause hospitalization or all-cause mortality, the composite primary endpoint, occurred in 10,943 (12.5%) patients. Compared with ACE inhibitors, the adjusted hazard for ARBs was 0.90 (95% confidence interval, 0.87-0.94) for all-cause hospitalization or mortality; 0.95 (0.65-1.40) for mortality; 0.90 (0.87-0.94) for all-cause hospitalization; and 0.81 (0.74-0.89) for cardiovascular admission. ARB use was associated with a reduced, not increased, risk of hospitalization/mortality relative to ACE inhibition. This was driven by lower hospitalization, with a null mortality result.
Department of Medicine, University of Alberta, Edmonton, AB, Canada.|Alberta Diabetes Institute, Edmonton, AB, Canada.
Raj
R
Padwal
Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, AB, Canada.|Alliance for Canadian Health Outcomes Research in Diabetes, University of Alberta, Edmonton, AB, Canada.
Mu
M
Lin
Alberta Diabetes Institute, Edmonton, AB, Canada.|Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, AB, Canada.|Alliance for Canadian Health Outcomes Research in Diabetes, University of Alberta, Edmonton, AB, Canada.
Dean T
DT
Eurich
D000328:Adult; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000378:metabolism / Q000401:mortality; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors