More evidence supporting ACE inhibitors for diabetic patients

28 May
2004

ACE Inhibitors Improve Survival in Type 2 Diabetes . Since many readers have not registered at Medscape (all physicians should I believe), here is a substantial quote:

Angiotensin-converting enzyme (ACE) inhibitors significantly reduce all-cause mortality in patients with type 2 diabetes who do not have a history of cardiovascular disease, according to the results of a cohort study published in the June issue of Diabetes Care.

“ACE inhibitor therapy is widely used in lower-risk patients with type 2 diabetes to reduce mortality, despite limited evidence to support this clinical strategy,” write Dean T. Eurich, BSP, MSC, from the Institute of Health Economics in Edmonton, Alberta, Canada, and colleagues.

Using the Saskatchewan health databases, the investigators identified 12,272 new users of oral hypoglycemic agents during the period from 1991 to 1996. After exclusion of 3,202 subjects with previous cardiovascular disease, 1,187 “new users” of ACE inhibitors remained, as did 4,989 control subjects not receiving ACE inhibitors throughout the follow-up period.

Subjects were followed up prospectively for an average duration of 5.3 ± 2.1 years until death or the end of 1999. Mean duration of ACE inhibitor therapy was 3.6 ± 1.8 years. Compared with the control cohort, the ACE inhibitor cohort had significantly fewer deaths (102 [8.6%] vs. 853 [17.1%]; adjusted hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.40 – 0.61; P < .001). Mortality from cardiovascular causes was also reduced in the ACE inhibitor group (40 [3.4%] vs. 261 [5.2%]; adjusted HR, 0.63; 95% CI, 0.44 - 0.90; P = .01).

Chlorthalidone person nonwithstanding, this study adds to the evidence supporting ACE inhibitor use for hypertensive diabetics. Many ACE inhibitors are now generic (and more will become so in the near future). ACE inhibitor therapy will probably cost between 50 cents and 1 dollar per day.

Clearly, many patients will need a diuretic added to achieve desired blood pressures (remember that our goal in diabetic patients is 130/80). Most ACE inhibitors offer a fixed combination with a low dose of hydrochlorothiaze.

I expect all adult onset diabetics to either be receiving an ACE inhibitor or have a documented contraindication (angioedema, intractable cough, or documented major creatinine increase). Practicing physicians might want to go and read the link, which provides a CME discussion of this issue.

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Related posts:

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3 Responses to More evidence supporting ACE inhibitors for diabetic patients

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John Anderson

May 28th, 2004 at 11:11 pm

“I expect all adult onset diabetics to either be receiving an ACE inhibitor or have a documented contraindication…”

Is this an “oops” moment? What happened to “for hypertensive diabetics”? This uninformed but curious recently-diagnosed 48-year-old diabetic with BP of 125/82 is curious.

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John Anderson

May 28th, 2004 at 11:12 pm

Oops myself: I’m 58, not 48.

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chlorthalidone prescriber

May 30th, 2004 at 12:17 am

Absolute Misquote Medrants.

ALLHAT was not about which medication to start in diabetics.

ACE-Is are a no-brainer for firstline HTN therapy for diabetics. Because ACE-Is don’t lower bp particularly well, a thiazide is almost always needed soon after.

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