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Diabetes mellitus as a compelling indication for use of renin angiotensin system blockers: systematic review and meta-analysis of randomized trials.
BMJ. 2016 Feb 11; 352:i438.BMJ

Abstract

OBJECTIVE

To evaluate the outcomes with use of renin angiotensin system (RAS) blockers compared with other antihypertensive agents in people with diabetes.

DESIGN

Meta-analysis.

DATA SOURCES AND STUDY SELECTION

PubMed, Embase, and the Cochrane central register of controlled trials databases for randomized trials of RAS blockers versus other antihypertensive agents in people with diabetes mellitus. Outcomes were death, cardiovascular death, myocardial infarction, angina, stroke, heart failure, revascularization, and end stage renal disease.

RESULTS

The search yielded 19 randomized controlled trials that enrolled 25,414 participants with diabetes for a total of 95,910 patient years of follow-up. When compared with other antihypertensive agents, RAS blockers were associated with a similar risk of death (relative risk 0.99, 95% confidence interval 0.93 to 1.05), cardiovascular death (1.02, 0.83 to 1.24), myocardial infarction (0.87, 0.64 to 1.18), angina pectoris (0.80, 0.58 to 1.11), stroke (1.04, 0.92 to 1.17), heart failure (0.90, 0.76 to 1.07), and revascularization (0.97, 0.77 to 1.22). There was also no difference in the hard renal outcome of end stage renal disease (0.99, 0.78 to 1.28) (power of 94% to show a 23% reduction in end stage renal disease).

CONCLUSIONS

In people with diabetes, RAS blockers are not superior to other antihypertensive drug classes such as thiazides, calcium channel blockers, and β blockers at reducing the risk of hard cardiovascular and renal endpoints. These findings support the recommendations of the guidelines of the European Society of Cardiology/European Society of Hypertension and eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure to also use other antihypertensive agents in people with diabetes but without kidney disease.

Authors+Show Affiliations

New York University School of Medicine, New York, NY, USA sripalbangalore@gmail.com.New York University School of Medicine, New York, NY, USA.Mount Sinai Beth Israel Medical Center, New York, NY, USA.Mount Sinai Health Medical Center, Icahn School of Medicine, New York, NY, USA.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

26868137

Citation

Bangalore, Sripal, et al. "Diabetes Mellitus as a Compelling Indication for Use of Renin Angiotensin System Blockers: Systematic Review and Meta-analysis of Randomized Trials." BMJ (Clinical Research Ed.), vol. 352, 2016, p. i438.
Bangalore S, Fakheri R, Toklu B, et al. Diabetes mellitus as a compelling indication for use of renin angiotensin system blockers: systematic review and meta-analysis of randomized trials. BMJ. 2016;352:i438.
Bangalore, S., Fakheri, R., Toklu, B., & Messerli, F. H. (2016). Diabetes mellitus as a compelling indication for use of renin angiotensin system blockers: systematic review and meta-analysis of randomized trials. BMJ (Clinical Research Ed.), 352, i438. https://doi.org/10.1136/bmj.i438
Bangalore S, et al. Diabetes Mellitus as a Compelling Indication for Use of Renin Angiotensin System Blockers: Systematic Review and Meta-analysis of Randomized Trials. BMJ. 2016 Feb 11;352:i438. PubMed PMID: 26868137.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diabetes mellitus as a compelling indication for use of renin angiotensin system blockers: systematic review and meta-analysis of randomized trials. AU - Bangalore,Sripal, AU - Fakheri,Robert, AU - Toklu,Bora, AU - Messerli,Franz H, Y1 - 2016/02/11/ PY - 2016/2/13/entrez PY - 2016/2/13/pubmed PY - 2016/6/17/medline SP - i438 EP - i438 JF - BMJ (Clinical research ed.) JO - BMJ VL - 352 N2 - OBJECTIVE: To evaluate the outcomes with use of renin angiotensin system (RAS) blockers compared with other antihypertensive agents in people with diabetes. DESIGN: Meta-analysis. DATA SOURCES AND STUDY SELECTION: PubMed, Embase, and the Cochrane central register of controlled trials databases for randomized trials of RAS blockers versus other antihypertensive agents in people with diabetes mellitus. Outcomes were death, cardiovascular death, myocardial infarction, angina, stroke, heart failure, revascularization, and end stage renal disease. RESULTS: The search yielded 19 randomized controlled trials that enrolled 25,414 participants with diabetes for a total of 95,910 patient years of follow-up. When compared with other antihypertensive agents, RAS blockers were associated with a similar risk of death (relative risk 0.99, 95% confidence interval 0.93 to 1.05), cardiovascular death (1.02, 0.83 to 1.24), myocardial infarction (0.87, 0.64 to 1.18), angina pectoris (0.80, 0.58 to 1.11), stroke (1.04, 0.92 to 1.17), heart failure (0.90, 0.76 to 1.07), and revascularization (0.97, 0.77 to 1.22). There was also no difference in the hard renal outcome of end stage renal disease (0.99, 0.78 to 1.28) (power of 94% to show a 23% reduction in end stage renal disease). CONCLUSIONS: In people with diabetes, RAS blockers are not superior to other antihypertensive drug classes such as thiazides, calcium channel blockers, and β blockers at reducing the risk of hard cardiovascular and renal endpoints. These findings support the recommendations of the guidelines of the European Society of Cardiology/European Society of Hypertension and eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure to also use other antihypertensive agents in people with diabetes but without kidney disease. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/26868137/Diabetes_mellitus_as_a_compelling_indication_for_use_of_renin_angiotensin_system_blockers:_systematic_review_and_meta_analysis_of_randomized_trials_ L2 - https://www.bmj.com/lookup/pmidlookup?view=long&pmid=26868137 DB - PRIME DP - Unbound Medicine ER -