ACE Inhibitors Reduce Albuminuria Better Than ARBs in Patients With Type 2 Diabetes

June 7, 2011 -- Angiotensin-converting enzyme (ACE) inhibitors reduce albuminuria better than angiotensin receptor blockers (ARBs) in patients with type 2 diabetes, researchers said here on June 5 at the 93rd Annual Meeting of the Endocrine Society (ENDO)

Previous studies have shown that ACE inhibitors and ARBs improve the surrogate markers for and reduce cardiovascular disease, renal disease, and stroke. In fact, most of the studies have shown no major difference between the 2 treatments in reducing cardiovascular and renal end points.

However, no study has directly compared ACE inhibitors with ARBs as a class effect in patients with type 2 diabetes with respect to overall mortality and morbidity.

Nasreen A. Al-Sayed, MD, Department of Endocrinology and Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio, and colleagues reviewed electronic medical records from the Cleveland Clinic Health System (1998-2006) and identified 12,353 patients on ACE inhibitors and 4,138 patients on ARBs. All patients were aged 18 years and older with type 2 diabetes.

There were no significant differences in overall survival rates between patients taking ACE inhibitors and those taking ARBs (P =.12) and no significant differences in coronary artery disease events (P =.991).

When the 2 groups were compared for renal events, the model was divided into creatinine doubling and albuminuria. Concerning creatinine doubling, ARBs increased the risk compared with ACE inhibitors, but the difference was only marginally significant (P =.097). Patients who received ARBs had a higher rate of albuminuria than patients who received ACE inhibitors -- a statistically significant difference (P =.012).

“This is a striking finding,” said Dr. Al-Sayed. “Our study is one of the first that has compared these agents as a class in type 2 diabetics, and suggests that ACE inhibitors may be better to prevent renal disease than ARBs in these patients.”

“This study also shows that these agents may be effective in preventing renal disease early in the course of the disease -- prior to the development of any clinically significant albuminuria,” he said.

[Presentation title: ACE Inhibitors Reduce Albuminuria More Than ARBS in Type 2 Diabetics. Abstract 616]