title: Comparative effectiveness of angiotensin-converting-enzyme inhibitors and angiotensin II receptor blockers in patients with type 2 diabetes and retinopathy.
abstract: BACKGROUND
  Angiotensin-converting-enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are effective treatments for diabetic retinopathy, but randomized trials and meta-analyses comparing their effects on macrovascular complications have yielded conflicting results. We compared the effectiveness of these drugs in patients with pre-existing diabetic retinopathy in a large population-based cohort.
  
  
  METHODS
  We conducted a propensity score-matched cohort study using Taiwan's National Health Insurance Research Database. We included adult patients prescribed an ACE inhibitor or ARB within 90 days after diagnosis of diabetic retinopathy between 2000 and 2010. Primary outcomes were all-cause death and major adverse cardiovascular events (myocardial infarction, ischemic stroke or cardiovascular death). Secondary outcomes were hospital admissions with acute kidney injury or hyperkalemia.
  
  
  RESULTS
  We identified 11 246 patients receiving ACE inhibitors and 15 173 receiving ARBs, of whom 9769 patients in each group were matched successfully by propensity scores. In the intention-to-treat analyses, ARBs were similar to ACE inhibitors in risk of all-cause death (hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.87-1.01) and major adverse cardiovascular events (HR 0.95, 95% CI 0.87-1.04), including myocardial infarction (HR 1.03, 95% CI 0.88-1.20), ischemic stroke (HR 0.94, 95% CI 0.85-1.04) and cardiovascular death (HR 1.01, 95% CI 0.88-1.16). They also did not differ from ACE inhibitors in risk of hospital admission with acute kidney injury (HR 1.01, 95% CI 0.91-1.13) and hospital admission with hyperkalemia (HR 1.01, 95% CI 0.86-1.18). Results were similar in as-treated analyses.
  
  
  CONCLUSIONS
  Our study showed that ACE inhibitors were similar to ARBs in risk of all-cause death, major adverse cardiovascular events and adverse effects among patients with pre-existing diabetic retinopathy.
authors.affiliation: School of Medicine (Shih, H.-T. Chen, Kuo, Li, Y.-T. Chen), National Yang-Ming University, Taipei; Department of Medicine (Shih), Taipei Veterans General Hospital, Yuanshan Branch, Yuanshan, Taiwan; Division of Endocrinology and Metabolism (H.-T. Chen), Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei; National Institute of Infectious Diseases and Vaccinology (Kuo), National Health Research Institutes, Zhunan, Taiwan; Divisions of Infectious Diseases (Kuo) and Nephrology (Li, Ou), Department of Medicine, Taipei Veterans General Hospital, Taipei; Department of Nursing (Lai), Taipei Veterans General Hospital, Yuanshan Branch, Yuanshan; Department of Nursing (S.-C. Chen), and Division of Nephrology (Y.-T. Chen), Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan.
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Shih
authors.affiliation: School of Medicine (Shih, H.-T. Chen, Kuo, Li, Y.-T. Chen), National Yang-Ming University, Taipei; Department of Medicine (Shih), Taipei Veterans General Hospital, Yuanshan Branch, Yuanshan, Taiwan; Division of Endocrinology and Metabolism (H.-T. Chen), Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei; National Institute of Infectious Diseases and Vaccinology (Kuo), National Health Research Institutes, Zhunan, Taiwan; Divisions of Infectious Diseases (Kuo) and Nephrology (Li, Ou), Department of Medicine, Taipei Veterans General Hospital, Taipei; Department of Nursing (Lai), Taipei Veterans General Hospital, Yuanshan Branch, Yuanshan; Department of Nursing (S.-C. Chen), and Division of Nephrology (Y.-T. Chen), Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan.
authors.forename: Hung-Ta
authors.initials: HT
authors.lastname: Chen
authors.affiliation: School of Medicine (Shih, H.-T. Chen, Kuo, Li, Y.-T. Chen), National Yang-Ming University, Taipei; Department of Medicine (Shih), Taipei Veterans General Hospital, Yuanshan Branch, Yuanshan, Taiwan; Division of Endocrinology and Metabolism (H.-T. Chen), Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei; National Institute of Infectious Diseases and Vaccinology (Kuo), National Health Research Institutes, Zhunan, Taiwan; Divisions of Infectious Diseases (Kuo) and Nephrology (Li, Ou), Department of Medicine, Taipei Veterans General Hospital, Taipei; Department of Nursing (Lai), Taipei Veterans General Hospital, Yuanshan Branch, Yuanshan; Department of Nursing (S.-C. Chen), and Division of Nephrology (Y.-T. Chen), Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan.
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Kuo
authors.affiliation: School of Medicine (Shih, H.-T. Chen, Kuo, Li, Y.-T. Chen), National Yang-Ming University, Taipei; Department of Medicine (Shih), Taipei Veterans General Hospital, Yuanshan Branch, Yuanshan, Taiwan; Division of Endocrinology and Metabolism (H.-T. Chen), Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei; National Institute of Infectious Diseases and Vaccinology (Kuo), National Health Research Institutes, Zhunan, Taiwan; Divisions of Infectious Diseases (Kuo) and Nephrology (Li, Ou), Department of Medicine, Taipei Veterans General Hospital, Taipei; Department of Nursing (Lai), Taipei Veterans General Hospital, Yuanshan Branch, Yuanshan; Department of Nursing (S.-C. Chen), and Division of Nephrology (Y.-T. Chen), Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan.
authors.forename: Szu-Yuan
authors.initials: SY
authors.lastname: Li
authors.affiliation: School of Medicine (Shih, H.-T. Chen, Kuo, Li, Y.-T. Chen), National Yang-Ming University, Taipei; Department of Medicine (Shih), Taipei Veterans General Hospital, Yuanshan Branch, Yuanshan, Taiwan; Division of Endocrinology and Metabolism (H.-T. Chen), Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei; National Institute of Infectious Diseases and Vaccinology (Kuo), National Health Research Institutes, Zhunan, Taiwan; Divisions of Infectious Diseases (Kuo) and Nephrology (Li, Ou), Department of Medicine, Taipei Veterans General Hospital, Taipei; Department of Nursing (Lai), Taipei Veterans General Hospital, Yuanshan Branch, Yuanshan; Department of Nursing (S.-C. Chen), and Division of Nephrology (Y.-T. Chen), Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan.
authors.forename: Pi-Hsiang
authors.initials: PH
authors.lastname: Lai
authors.affiliation: School of Medicine (Shih, H.-T. Chen, Kuo, Li, Y.-T. Chen), National Yang-Ming University, Taipei; Department of Medicine (Shih), Taipei Veterans General Hospital, Yuanshan Branch, Yuanshan, Taiwan; Division of Endocrinology and Metabolism (H.-T. Chen), Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei; National Institute of Infectious Diseases and Vaccinology (Kuo), National Health Research Institutes, Zhunan, Taiwan; Divisions of Infectious Diseases (Kuo) and Nephrology (Li, Ou), Department of Medicine, Taipei Veterans General Hospital, Taipei; Department of Nursing (Lai), Taipei Veterans General Hospital, Yuanshan Branch, Yuanshan; Department of Nursing (S.-C. Chen), and Division of Nephrology (Y.-T. Chen), Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan.
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Chen
authors.affiliation: School of Medicine (Shih, H.-T. Chen, Kuo, Li, Y.-T. Chen), National Yang-Ming University, Taipei; Department of Medicine (Shih), Taipei Veterans General Hospital, Yuanshan Branch, Yuanshan, Taiwan; Division of Endocrinology and Metabolism (H.-T. Chen), Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei; National Institute of Infectious Diseases and Vaccinology (Kuo), National Health Research Institutes, Zhunan, Taiwan; Divisions of Infectious Diseases (Kuo) and Nephrology (Li, Ou), Department of Medicine, Taipei Veterans General Hospital, Taipei; Department of Nursing (Lai), Taipei Veterans General Hospital, Yuanshan Branch, Yuanshan; Department of Nursing (S.-C. Chen), and Division of Nephrology (Y.-T. Chen), Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan.
authors.forename: Shuo-Ming
authors.initials: SM
authors.lastname: Ou
authors.affiliation: School of Medicine (Shih, H.-T. Chen, Kuo, Li, Y.-T. Chen), National Yang-Ming University, Taipei; Department of Medicine (Shih), Taipei Veterans General Hospital, Yuanshan Branch, Yuanshan, Taiwan; Division of Endocrinology and Metabolism (H.-T. Chen), Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei; National Institute of Infectious Diseases and Vaccinology (Kuo), National Health Research Institutes, Zhunan, Taiwan; Divisions of Infectious Diseases (Kuo) and Nephrology (Li, Ou), Department of Medicine, Taipei Veterans General Hospital, Taipei; Department of Nursing (Lai), Taipei Veterans General Hospital, Yuanshan Branch, Yuanshan; Department of Nursing (S.-C. Chen), and Division of Nephrology (Y.-T. Chen), Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan ytchen0117@gmail.com okokyytt@gmail.com.
authors.forename: Yung-Tai
authors.initials: YT
authors.lastname: Chen
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality; D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D003930:Diabetic Retinopathy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors