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ACE inhibitors favoured for first-line antihypertensive treatment in patients with diabetes

ACE inhibitors are the favoured option for first-line antihypertensive treatment in patients with diabetes, suggests a recent study.

The Taiwanese researchers conducted a meta-analysis of 63 randomised clinical trials of antihypertensive therapy in patients with diabetes to look at all-cause mortality, requirement for dialysis and the doubling of creatinine levels. Each study had a follow-up period of at least 12 months, with a total of 36,917 patients included overall. The studies used ACE inhibitors, ARBs and their combinations.

In the analysis 2,400 deaths were identified along with 766 patients who required dialysis, and 1099 patients whose serum creatinine levels doubled. Compare with placebo, only ACE inhibitors significantly reduced the doubling of serum creatinine levels with a 42% reduction rate, and only β-blockers showed a significant difference in mortality rates with a seven-fold increase. Comparisons among all treatment groups showed no statistical significance in the outcome of dialysis.

The researchers note that their analyses ‘show the renoprotective effects and superiority of using ACE inhibitors in patients with diabetes and also show the harmful effects of β-blockers’.

BMJ 2013, available online 24 October