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Effects of ACEI/ARB in hypertensive patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled studies.

Hao G, Wang Z, Guo R, Chen Z, Wang X, Zhang L, Li W - BMC Cardiovasc Disord (2014)

Bottom Line: The effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on cardiovascular (CV) risk in hypertensive patients with type 2 diabetes mellitus (T2 DM) are uncertain.PubMed and Embase databases were searched through January 2014 to identify studies meeting a priori inclusion criteria and references in the published articles were also reviewed.Treatment with ACE/ARBs results in significant reduction in CV events and mortality in hypertensive patients with T2 DM.

View Article: PubMed Central - PubMed

Affiliation: Division of Prevention & Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No, 167 Beilishi Road Xicheng District, Beijing 100037, China. wangzengwu@foxmail.com.

ABSTRACT

Background: The effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on cardiovascular (CV) risk in hypertensive patients with type 2 diabetes mellitus (T2 DM) are uncertain. Our objective was to analyze the effects of ACE/ARBs, on the incidence of myocardial infarction, stroke, CV events, and all-cause mortality in hypertensive patients with T2 DM.

Method: PubMed and Embase databases were searched through January 2014 to identify studies meeting a priori inclusion criteria and references in the published articles were also reviewed. Two investigators independently extracted the information with either fixed-effect model or random-effect model to assess the effects of ACE/ARBs treatment in hypertensive patients with T2 DM.

Results: Ten randomized controlled studies were included with a total of 21,871 participants. Overall, treatment with ACE/ARBs in hypertensive patients with T2 DM was associated with a statistically significant 10% reduction in CV events, pooled hazard ratio (HR) of 0.90 [95% confidence intervals (CI): 0.82-0.98] with no heterogeneity (I2 = 19.50%; P = 0.275);and 17% reduction in CV mortality, pooled HR of 0.83 [95% CI: 0.72-0.96] with no heterogeneity (I2 = 0.9%; P = 0.388). ACE/ARBs was not associated with MI, stroke and all-cause mortality.

Conclusions: Treatment with ACE/ARBs results in significant reduction in CV events and mortality in hypertensive patients with T2 DM.

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Related in: MedlinePlus

Flow chart of study selection.
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Fig1: Flow chart of study selection.

Mentions: We performed a systematic search of Pubmed and Embase databases through January 2014 for relevant studies performed in hypertensive patients with T2 DM. Subject headings and key words used for the literature search were as follows: 1) mortality, CV diseases, MI and stroke; 2) hypertension and diabetes; 3) angiotensin-converting enzyme inhibitors and angiotensin receptor blockers; 4) RCTs. The titles, abstracts and full-texts were reviewed independently by two reviewers. The criteria for eligible studies were as follows: 1) Randomized clinical trials in hypertensive patients with T2 DM comparing active treatment with ACE inhibitors or ARBs with control treatment (placebo, life style changes, active antihypertensive treatment with drugs other than ACEI or ARB); 2) The endpoints were mortality, CV events, MI or stroke; 3) Hazard ratios (HR) were calculated with the corresponding confidence intervals (CI). Following this search, references of published articles were also reviewed. Finally, 10 RCTs were selected, out of them, IDNT data was used in two articles for the analysis of different endpoint events [14, 17] (FigureĀ 1).Figure 1


Effects of ACEI/ARB in hypertensive patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled studies.

Hao G, Wang Z, Guo R, Chen Z, Wang X, Zhang L, Li W - BMC Cardiovasc Disord (2014)

Flow chart of study selection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4221690&req=5

Fig1: Flow chart of study selection.
Mentions: We performed a systematic search of Pubmed and Embase databases through January 2014 for relevant studies performed in hypertensive patients with T2 DM. Subject headings and key words used for the literature search were as follows: 1) mortality, CV diseases, MI and stroke; 2) hypertension and diabetes; 3) angiotensin-converting enzyme inhibitors and angiotensin receptor blockers; 4) RCTs. The titles, abstracts and full-texts were reviewed independently by two reviewers. The criteria for eligible studies were as follows: 1) Randomized clinical trials in hypertensive patients with T2 DM comparing active treatment with ACE inhibitors or ARBs with control treatment (placebo, life style changes, active antihypertensive treatment with drugs other than ACEI or ARB); 2) The endpoints were mortality, CV events, MI or stroke; 3) Hazard ratios (HR) were calculated with the corresponding confidence intervals (CI). Following this search, references of published articles were also reviewed. Finally, 10 RCTs were selected, out of them, IDNT data was used in two articles for the analysis of different endpoint events [14, 17] (FigureĀ 1).Figure 1

Bottom Line: The effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on cardiovascular (CV) risk in hypertensive patients with type 2 diabetes mellitus (T2 DM) are uncertain.PubMed and Embase databases were searched through January 2014 to identify studies meeting a priori inclusion criteria and references in the published articles were also reviewed.Treatment with ACE/ARBs results in significant reduction in CV events and mortality in hypertensive patients with T2 DM.

View Article: PubMed Central - PubMed

Affiliation: Division of Prevention & Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No, 167 Beilishi Road Xicheng District, Beijing 100037, China. wangzengwu@foxmail.com.

ABSTRACT

Background: The effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on cardiovascular (CV) risk in hypertensive patients with type 2 diabetes mellitus (T2 DM) are uncertain. Our objective was to analyze the effects of ACE/ARBs, on the incidence of myocardial infarction, stroke, CV events, and all-cause mortality in hypertensive patients with T2 DM.

Method: PubMed and Embase databases were searched through January 2014 to identify studies meeting a priori inclusion criteria and references in the published articles were also reviewed. Two investigators independently extracted the information with either fixed-effect model or random-effect model to assess the effects of ACE/ARBs treatment in hypertensive patients with T2 DM.

Results: Ten randomized controlled studies were included with a total of 21,871 participants. Overall, treatment with ACE/ARBs in hypertensive patients with T2 DM was associated with a statistically significant 10% reduction in CV events, pooled hazard ratio (HR) of 0.90 [95% confidence intervals (CI): 0.82-0.98] with no heterogeneity (I2 = 19.50%; P = 0.275);and 17% reduction in CV mortality, pooled HR of 0.83 [95% CI: 0.72-0.96] with no heterogeneity (I2 = 0.9%; P = 0.388). ACE/ARBs was not associated with MI, stroke and all-cause mortality.

Conclusions: Treatment with ACE/ARBs results in significant reduction in CV events and mortality in hypertensive patients with T2 DM.

Show MeSH
Related in: MedlinePlus