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
The authors conclude that ACE inhibitors “should be considered as
first-line therapy to limit the excess mortality and morbidity in this
JAMA Internal Medicine article