ACC 2014 Report: ACE Inhibitors better than ARBs in CV patients with diabetes

Report from the ACC Annual Scientific Meeting, 29 – 31 March 2014 in Washington.   Angiotensin-converting-enzyme (ACE) inhibitors are associated with reduced mortality and cardiovascular events in patients with diabetes, while angiotensin-receptor blockers (ARBs) have little effect, according to a meta-analysis in JAMA Internal Medicine.

Researchers assessed the results of 35 randomized, controlled studies comprising some 56,000 patients. Participants had been randomized to either the active group (ACE inhibitors or ARBs) or a comparator group (placebo, no treatment, or other antihypertensive drugs).

Use of ACE inhibitors was associated with a 13% to 17% risk reduction in all-cause mortality, cardiovascular mortality, and major cardiovascular events. ARB users did not see a similar benefit. However, ARBs were associated with a 30% risk reduction in heart failure.

The researchers showed that  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.

The authors conclude that ACE inhibitors “should be considered as first-line therapy to limit the excess mortality and morbidity in this population.”

JAMA Internal Medicine article (Free abstract)

Reference: JAMA Intern Med. Published online March 31, 2014. doi:10.1001/jamainternmed.2014.348