Angiotensin-Converting Enzyme Inhibitors Reduce Albuminuria More than Angiotensin Receptor Blockers in Patients with Type 2 Diabetes |
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| Affiliation: | 1. Department of Endocrinology and Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio;2. Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio;1. Division of Endocrinology, “V. Fazzi” Hospital, Lecce, Italy;2. Endocrine Unit and Thyroid Diseases Center, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia;3. Department of Endocrinology and Metabolism, Thessaloniki, Greece;4. Department of Pathology,“V. Fazzi” Hospital, Lecce, Italy;5. Institute of Pathology, Locarno, Switzerland;6. Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland;7. Department of Pathology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy;1. Boston Children’s Hospital, Division of Endocrinology, Boston, Massachusetts;2. Case Western Reserve University School of Medicine, Cleveland, Ohio;3. Boston University School of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Boston, Massachusetts.;1. Department of Gastroenterology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India;2. Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.;3. DDepartment of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India;4. Department of Surgical Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.;1. The John A. Hartford Foundation Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, the;2. Department of Obstetrics, Gynecology & Women’s Health, John A. Burns School of Medicine, University of Hawaii, the;3. Kuakini Medical Center, and the;4. Miki Medical Associates, Honolulu, Hawai.;1. Division of Neuroendocrinology, Beaumont Hospital & the RCSI Medical School, Dublin, Ireland. |
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| Abstract: | ObjectiveThis study retrospectively compared the effects of angiotensin-converting enzyme inhibitors (ACEIs) versus angiotensin receptor blockers (ARBs) as classes with respect to overall mortality and cardiovascular and renal events in patients with type 2 diabetes.MethodsAn electronic database of medical records was reviewed. A total of 16,489 patients with type 2 diabetes were enrolled and divided into ACEI (n = 12,351) or ARB (n = 4,138) groups. Baseline patient characteristics were compared using univariable analysis. A chi-square test was used for categorical outcomes, and the propensity class was calculated using multivariable logistic regression. Survival analysis was performed to evaluate the effect of ACEIs/ARBs on overall survival, coronary artery disease (CAD), and renal events via Cox regression analysis, adjusting for propensity class and baseline variables. All statistical analyses were conducted using R 2.15.1 software.ResultsNo significant differences in overall survival (P = .16) and CAD (P = .81) events were observed between groups. With respect to renal events, ARBs increased the risk of creatinine doubling compared with ACEIs, but the difference was not significant (hazard ratio [HR], 1.207; 95% confidence interval [CI], 0.921-1.583; P = .173). Patients who received ARBs had a significantly higher rate of albuminuria than patients who received ACEIs (HR, 1.303; 95% CI, 1.053-1.612; P = .015).ConclusionThe early effects of ACEIs and ARBs on albuminuria outcome seem to be different in type 2 diabetes, favoring the use of ACEIs. A well-designed prospective study is warranted to evaluate this finding. (Endocr Pract. 2013;19:579-586) |
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