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ACE inhibitors should be favoured over ARBs in patients with diabetes

ACE inhibitors can reduce all-cause mortality, cardiovascular mortality, and major cardiovascular events in patients with diabetes, whereas ARBs have no benefits on these outcomes, suggests a recent study.

The study included randomised trials that observed patients over a minimum of 12 months, and compared ACE inhibitors and ARBs with placebo, no treatment, or versus other antihypertensive medications (control therapy). Primary end points were all-cause mortality and death from cardiovascular causes. Secondary end points were the effects of ACE inhibitors and ARBs on major cardiovascular events.

When compared with controls, ACE inhibitors significantly reduced the risk of all-cause mortality by 13%, cardiovascular deaths by 17%, and major cardiovascular events by 14%. Treatment with ARBs did not significantly affect all-cause mortality, cardiovascular death rate, and major cardiovascular events, compared with control therapy. Both ACE inhibitors and ARBs were not associated with a decrease in the risk of stroke in patients with diabetes.

The researchers advise that ‘ACE inhibitors should be considered as first-line therapy to limit excess mortality and morbidity in this population’.

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