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Pressure is growing for new guidance on use of ACE inhibitors in patients at risk of diabetes after a second study joined ASCOT in pushing for wider use.

Extended follow-up of the HOPE trial, published in Circulation, found long-term use of ramipril in patients with vascular disease cut risk of diabetes by 34 per cent.

'ACE inhibitor therapy should be used in most patients with vascular disease,' said study co-ordinator Jackie Bosch, assistant clinical professor at Canada's McMaster University.

Dr Eugene Hughes, member of the Primary Care Diabetes Society steering committee and an Isle of Wight GP, said: 'My gut feeling is first-line therapy should be with an ACE inhibitor but that's only [currently] recommended in patients with microalbuminuria.'

ASCOT found the risk of diabetes in hypertensives was 30 per cent lower with an ACE inhibitor/calcium channel blocker than a ?-blocker/diuretic.

ASCOT investigator Professor Neil Poulter said: 'The key issue is, can you predict who is going to get diabetes? But you should look at the results and ask yourself which combination would you take?'

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