Abstract
BackgroundThe effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on cardiovascular (CV) risk in hypertensive patients with type 2 diabetes mellitus (T2 DM) are uncertain. Our objective was to analyze the effects of ACE/ARBs, on the incidence of myocardial infarction, stroke, CV events, and all-cause mortality in hypertensive patients with T2 DM.MethodPubMed and Embase databases were searched through January 2014 to identify studies meeting a priori inclusion criteria and references in the published articles were also reviewed. Two investigators independently extracted the information with either fixed-effect model or random-effect model to assess the effects of ACE/ARBs treatment in hypertensive patients with T2 DM.ResultsTen randomized controlled studies were included with a total of 21,871 participants. Overall, treatment with ACE/ARBs in hypertensive patients with T2 DM was associated with a statistically significant 10% reduction in CV events, pooled hazard ratio (HR) of 0.90 [95% confidence intervals (CI): 0.82-0.98] with no heterogeneity (I2 = 19.50%; P = 0.275);and 17% reduction in CV mortality, pooled HR of 0.83 [95% CI: 0.72-0.96] with no heterogeneity (I2 = 0.9%; P = 0.388). ACE/ARBs was not associated with MI, stroke and all-cause mortality.ConclusionsTreatment with ACE/ARBs results in significant reduction in CV events and mortality in hypertensive patients with T2 DM.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2261-14-148) contains supplementary material, which is available to authorized users.
Highlights
The effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on cardiovascular (CV) risk in hypertensive patients with type 2 diabetes mellitus (T2 DM) are uncertain
Treatment with ACE/ARBs in hypertensive patients with T2 DM was associated with a statistically significant 10% reduction in CV events, pooled hazard ratio (HR) of 0.90 [95% confidence intervals (CI): 0.82-0.98] with no heterogeneity (I2 = 19.50%; P = 0.275); and 17% reduction in CV mortality, pooled HR of 0.83 [95% CI: 0.72-0.96] with no heterogeneity (I2 = 0.9%; P = 0.388)
ACE/ARBs was not associated with myocardial infarction (MI), stroke and all-cause mortality
Summary
The effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on cardiovascular (CV) risk in hypertensive patients with type 2 diabetes mellitus (T2 DM) are uncertain. The use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), could reduce both CV morbidity and mortality. The beneficial effect of ACE inhibitor treatment on allcause mortality for hypertensive patients was well established in a recent meta-analysis [9]. The Heart Outcomes Prevention Evaluation (HOPE) study showed that treatment with Ramipril reduced cardiovascular events in patients with diabetes, out of which 56% were hypertensive [10]. The Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial (FACET) and Captopril Prevention Project (CAPPP) study demonstrated that the ACE inhibitors fosinopril could significantly reduce risk of major vascular events in hypertensive diabetic patients compared with controls [11,12]. Other studies like the Irbesartan Diabetic Nephropathy Trial (IDNT) or The Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation
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