ACE Inhibitors and other Antihypertensive Drugs in Patients with Type 2 Diabetes

A systematic review 1 including 4 RCTs with a total of 2 180 subjects was abstracted in DARE. The analysis showed a statistically-significant benefit of ACE inhibitors on the outcome of acute myocardial infarction, compared with alternative treatments there was a 63% reduction (P <0.001) and the RR was 0.37 (95% CI: 0.24 to 0.57). On the outcome of cardiovascular events, compared with alternative treatments there was a 51% reduction and the RR was 0.49 (95% CI: 0.36 to 0.67). Also, there was a benefit of ACE inhibitors on the outcome of all-cause mortality, compared with alternative treatments there was a 62% reduction (P=0.010) and the RR was 0.57 (95% CI: 0.38 to 0.87). ACE inhibitors did not appear to be superior to other agents for the outcome of stroke in any of the trials, RR 0.76 (95% CI: 0.48 to 1.22).

The following decision support rules contain links to this evidence summary:

• ACE inhibitors or angiotensin-receptor blockers for patients with diabetes and hypertension but no microalbuminuria http://www.ebmeds.org/ebmeds/ebmeds_home.asp?mode=scripts&submode=view&id=scr00581&country=UK

References

• Pahor M, Psaty BM, Alderman MH, Applegate WB, Williamson JD, Furberg CD. Therapeutic benefits of ACE inhibitors and other antihypertensive drugs in patients with type 2 diabetes. Diabetes Care 2000 Jul;23(7):888-92. [PubMed] [DARE]