Diabetes Q&A

ACE vs. ARB: Which is Best In Patients With Diabetes?

No blood pressure-lowering strategies increased survival rates in patients with diabetes and chronic kidney disease (CKD), according to a recent study.

“The comparative efficacy and safety of pharmacological agents to lower blood pressure in adults with diabetes and kidney disease remains controversial,” explained the study’s authors. “We aimed to investigate the benefits and harms of blood pressure-lowering drugs in this population of patients.”
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For their meta-analysis, researchers evaluated 157 studies including 43,256 participants with type 2 diabetes or CKD to compare the impact of orally administered blood pressure-lowering drugs, including angiotensin-converting-enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), and endothelin inhibitors.

The study showed that while no drug therapy was more effective than placebo for decreasing death rates, risk of end-stage renal disease was significantly reduced after treatment with a ARBs and ACE inhibitors, compared to placebo.

Researchers noted that combined ACE inhibitors and ARB treatment yielded borderline increases in risk of hyperkalemia (odds ratio 2.69) and acute kidney injury (odds ratio 2.69).

“Any benefits of combined ACE inhibitor and ARB treatment need to be balanced against potential harms of hyperkalaemia and acute kidney injury,” they concluded.

The complete study is published in the May issue of the Lancet.

-Michelle Canales Butcher

Reference:
1. Palmer SC, Mavridis D, Navarese E, et al. Comparative efficacy and safety of blood pressure-lowering agents in adults with diabetes and kidney disease: a network meta-analysis. Lancet. 2015 May [epub ahead of print] doi: http://dx.doi.org/10.1016/S0140-6736(14)62459-4 .