Abstract
BackgroundAngiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are considered to have similar renoprotective effects; so far there has been no consensus about their priorities. This study aimed to compare ACEIs and ARBs for major renal outcomes and survival in a 15-year cohort of adults with diabetes.MethodsThis study utilized Taiwan’s medical and pharmacy claims data in the Longitudinal Cohort of Diabetes Patients. The primary outcome was long-term dialysis, and secondary outcomes were hospitalization for acute kidney injury, hospitalization for hyperkalemia, all-cause death, cardiovascular death, and non-cardiovascular death. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes comparing ACEIs with ARBs. We conducted subgroup analyses and interaction tests among patients with different age and comorbid diseases.ResultsA total of 34,043 patients received ACEIs and 23,772 patients received ARBs. No differences were found for primary or secondary outcomes in the main analyses. ACEIs showed significantly lower hazard than ARBs for long-term dialysis among patients with cardiovascular disease (HR 0.80, 95% CI 0.66–0.97, interaction P = 0.003) or chronic kidney disease (0.81, 0.71–0.93, interaction P = 0.001).ConclusionsOur analyses show similar effects of ACEIs and ARBs in patients with diabetes. However, ACEIs might provide additional renoprotective effects among patients who have cardiovascular disease or chronic kidney disease.
Highlights
Our analyses show similar effects of Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in patients with diabetes
The development and progression of chronic kidney disease are closely interrelated to hypertension [1, 2], and aggressive blood pressure-lowering management is able to decrease the risk of decline in renal function among patients with diabetes [3,4,5]
Compared with ARB therapy, ACEI therapy showed significantly lower hazard for long-term dialysis among participants with cardiovascular disease (HR 0.80, 95% confidence intervals (CIs) 0.66–0.97) or chronic kidney disease (0.81, 0.71–0.93), and the interaction tests were significant (P = 0.003 for cardiovascular disease; P = 0.001 for chronic kidney disease)
Summary
The development and progression of chronic kidney disease are closely interrelated to hypertension [1, 2], and aggressive blood pressure-lowering management is able to decrease the risk of decline in renal function among patients with diabetes [3,4,5]. The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) study, the largest randomized clinical trial comparing an ACEI with an ARB, reported similar effects on major renal outcomes in a study population with one-third of patients had diabetes [15]. A well-designed observational study can provide adequate participants numbers and follow-up time so as to achieve sufficient power for differentiating effects between ACEIs and ARBs. A few cohort studies compared ACEIs with ARBs for renoprotective effects on patients with diabetes but interpretation was limited by the surrogate renal outcomes or the male veteran population [18,19]. Our study aimed to compare ACEIs with ARBs for major renal outcomes and survival in a 15-year cohort of patients with diabetes, and assess the effects among patients with different age and comorbid diseases. This study aimed to compare ACEIs and ARBs for major renal outcomes and survival in a 15-year cohort of adults with diabetes.
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