Heart and kidney benefits come from Angiotensin Converting Enzyme Inhibitors. Well know for a long time.
Angiotensin II Receptor Blockers didn’t perform so well and they are more expensive by far.
PAY ATTENTION YOU OLD GUYS, ACE INHIBITORS ARE VERY IMPORTANT FOR PEOPLE WITH HEART AND DIABETIC KIDNEY DISEASE AS WELL AS HYPERTENSION. ACE INHIBITORS HAVE REHABILITATIVE EFFECTS ON HEARTS TOO.
TAKE-HOME MESSAGE
This meta-analysis analyzed the effect of ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) on all-cause mortality, cardiovascular (CV) deaths, and major CV events in patients with diabetes mellitus (DM). The major results of 35 trials and > 50,000 patients showed that ACEIs reduced all-cause mortality, CV mortality, and major CV events in patients with DM. By contrast, ARBs did not reduce all-cause mortality, CV mortality, or major CV events. Neither ACEIs nor ARBs were associated with a decrease in the risk for stroke in patients with DM.
This study suggests that ACEIs be used as first-line therapy in patients with diabetes compared with ARBs.
JAMA internal medicine
Effect of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on All-Cause Mortality, Cardiovascular Deaths, and Cardiovascular Events in Patients With Diabetes Mellitus: A Meta-Analysis
This is a good type of metaanalysis, since it is a simple endpoint not some tortured one–all cause mortality.
JAMA Intern Med 2014 Mar 31;[EPub Ahead of Print], J Cheng, W Zhang, X Zhang, F Han, X Li, X He, Q Li, J Chen
– Moshe Ornstein, MD
ABSTRACT
IMPORTANCE
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) may have different effects on cardiovascular (CV) events in patients with diabetes mellitus (DM).
OBJECTIVE
To conduct a meta-analysis to separately evaluate the effects of ACEIs and ARBs on all-cause mortality, CV deaths, and major CV events in patients with DM.
DATA SOURCES
Data sources included MEDLINE (1966-2012), EMBASE (1988-2012), the Cochrane Central Register of Controlled Trials, conference proceedings, and article reference lists.
STUDY SELECTION
We included randomized clinical trials reporting the effects of ACEI and ARB regimens for DM on all-cause mortality, CV deaths, and major CV events with an observation period of at least 12 months. Studies were excluded if they were crossover trials.
DATA EXTRACTION AND SYNTHESIS
Dichotomous outcome data from individual trials we reanalyzed using the risk ratio (RR) measure and its 95%CI with random-effects models. We estimated the difference between the estimates of the subgroups according to tests for interaction. We performed meta-regression analyses to identify sources of heterogeneity.
MAIN OUTCOMES AND MEASURES
Primary end points were all-cause mortality and death from CV causes. Secondary end points were the effects of ACEIs and ARBs on major CV events.
RESULTS
Twenty-three of 35 identified trials compared ACEIs with placebo or active drugs(32 827 patients) and 13 compared ARBs with no therapy (controls) (23 867 patients). When compared with controls (placebo/active treatment), ACEIs significantly reduced the risk offal-cause mortality by 13%(RR, 0.87; 95%CI, 0.78-0.98), CV deaths by 17%(0.83;0.70-0.99), and major CV events by 14%(0.86; 0.77-0.95), including myocardial infarction by 21% (0.79; 0.65-0.95) and heart failure by 19% (0.81; 0.71-0.93). Treatment with ARBs did not significantly affect all-cause mortality (RR, 0.94; 95%CI, 0.82-1.08), CV death rate (1.21;0.81-1.80), and major CV events (0.94; 0.85-1.01) with the exception of heart failure (0.70;0.59-0.82). Both ACEIs and ARBs were not associated with a decrease in the risk for stroke in patients with DM. Meta-regression analysis showed that the ACEI treatment effect on all-cause mortality and CV death did not vary significantly with the starting baseline blood pressure and proteinuria of the trial participants and the type of ACEI and DM.
CONCLUSIONS AND RELEVANCE
Angiotensin-converting enzyme inhibitors reduced all-cause mortality, CV mortality, and major CV events in patients with DM, whereas ARBs had no benefits on these outcomes. Thus, ACEIs should be considered as first-line therapy to limit excess mortality and morbidity in this population.
This abstract is available on the publisher’s site.