0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
ACP Journal Club |

Review: In diabetes, ACE-Is, but not ARBs, reduce mortality and major CV events compared with placebo or active treatment

Ann Intern Med. 2014;161(4):JC2. doi:10.7326/0003-4819-161-4-201408190-02002
Text Size: A A A

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
ACEIs are good but ARBs should not be ignored
Posted on September 2, 2014
Gauranga Dhar
Bangladesh Institute of Family Medicine and Research
Conflict of Interest: None Declared
This is a very good article where ACEIs found superior to ARBs in reducing cardiovascular and all cause mortality in diabetic population. This study must have a good practical implication. On the other hand beneficial effects of ARBs also cannot be ignored.
Insulin resistance probably one of the main causes of comorbidities/adverse events in type 2 diabetes patients. Some studies suggest that both ACEIs and ARBs increase skeletal muscle blood flow, hence increase insulin sensitivity. A meta-analysis performed by Mid America Heart Institute (Kansas) showed that due to beneficial effects on insulin resistance, both ARBs and ACEIs, lead to decreased number of new onset of type 2 diabetes. 24% reduction found by ACEIs and 23% by ARBs. Exactly same result was found in VALUE trial where valsartan was associated with 23% reduction of new onset of type 2 diabetes.
ADA guideline on “Hypertension management in adults with diabetes” suggests that patients with clinical nephropathy, ACEIs are first line drug in both type 1 and type 2 diabetes. On the other hand, ARBs should be considered as first line antihypertensive agents in patients with clinical nephropathy associated with type 2 diabetes.

Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)