Angiotensin converting enzyme inhibitors or angiotensin receptor blockers: evidence for their effects on mortality and major cardiovascular events in hypertensive diabetics
DOI:
https://doi.org/10.32385/rpmgf.v32i5.11887Keywords:
Diabetes mellitus, Hypertension, Inhibitors of angiotensin converting enzyme, Angiotensin receptor antagonistsAbstract
Objective: Our aim was to assess the evidence for the effects of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) on mortality and major cardiovascular events in individuals with hypertension and diabetes. Data Sources: National Guideline Clearinghouse, Guidelines Finder, Canadian Medical Association Practice Guidelines, Cochrane Library, DARE, Bandolier, MEDLINE, Index of Portuguese Medical Journals and General Directorate of Health databases. Methods: The two authors independently performed a search of meta-analyzes (MA), systematic reviews (SR), randomized clinical trials (RCT) and clinical practice guidelines (CPG), published between 31/08/2009 and 31/08/2014 in Portuguese, Spanish, English and French languages. We used the MeSH terms: Diabetes Mellitus AND Hypertension AND Angiotensin-Converting Enzyme Inhibitors OR Angiotensin Receptor Antagonists. The strength of recommendation taxonomy scale was used for the allocation of levels of evidence (LE) and strength of recommendation (SR). Results: Of the 478 articles found, we included five MA and sixCPG in this report. A Cochrane MA showed that ACE inhibitors significantly decreased mortality from all causes (LE 1) and one MA concluded that this class of medications decreased the risk of myocardial infarction (LE 1). The use of ARB was shown to decrease the risk of stroke in one MA. Another MA showed no significant differences between the two classes of drugs. A recent MA found that ACE inhibitors significantly decreased all-cause mortality, cardiovascular mortality, myocardial infarction, and heart failure (LE 1). In the same MA, ARB decreased the risk of heart failure. Most guidelines recommend ACE inhibitors or ARBs as first line therapy for hypertension in diabetic patients. Conclusions: The effects of ACE inhibitors and ARB on mortality and cardiovascular events appear to be different. We found consistent evidence favoring the use of ACE inhibitors as a first option in preventing morbidity and mortality in this population (SR A).Downloads
Downloads
Published
Issue
Section
License
The authors will assign to the RPMGF the sole right to publish and distribute the content of the manuscript specified in this declaration via physical, electronic, broadcasting or any other medium that may come into existence. They also grant the RPMGF the right to use and exploit this manuscript, in particular by assigning, selling or licensing its content. This permission is permanent and takes effect from the moment the manuscript is submitted, has the maximum duration allowed by applicable Portuguese or international law and is of worldwide scope. The authors further declare that this assignment is made free of charge. If the RPMGF informs the authors that it is not going to publish their manuscript, the exclusive assignment of rights ceases forthwith.
The authors authorise the RPMGF (or any entity it may appoint) to act on their behalf when it believes that copyright may have been infringed.
