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 
failure.

The authors conclude that ACE inhibitors “should be considered as 
first-line therapy to limit the excess mortality and morbidity in this 
population.”

JAMA Internal Medicine article