Tags

Type your tag names separated by a space and hit enter

First-line renin-angiotensin system inhibitors vs. other first-line antihypertensive drug classes in hypertensive patients with type 2 diabetes mellitus.
J Hum Hypertens. 2018 07; 32(7):494-506.JH

Abstract

First-line renin-angiotensin system (RAS) inhibitors are recommended for diabetic patients because of their potential nephron-protective properties. For hypertensive patients with type 2 diabetes mellitus, little is known about first-line RAS inhibitors vs. other first-line antihypertensive agents in terms of cardiovascular outcomes. We performed a meta-analysis of randomized controlled trials (RCTs) to assess the comparative efficacy of first-line RAS inhibitors vs. other first-line antihypertensive drug classes in hypertensive patients with type 2 diabetes mellitus. We identified RCTs by searching the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE up to December 15, 2015. Eighteen RCTs involving 18,862 participants were included. First-line RAS inhibitors were not different from first-line diuretics for all the primary outcomes. First-line RAS inhibitors reduced major cardiovascular events (2 RCTs, relative risk [RR] 0.78, 95% confidence interval [CI] 0.66, 0.91) and heart failure (4 RCTs, RR 0.72, 95% CI 0.61, 0.83) compared to first-line calcium channel blockers. Compared to β-blockers, RAS inhibitors reduced the risk of all-cause mortality (1 RCT, RR 0.63, 95% CI 0.47, 0.84), major cardiovascular events (1 RCT, RR 0.76, 95% CI 0.62, 0.93) and heart failure (1 RCT, RR 0.60, 95% CI 0.40, 0.92). Our meta-analysis indicates that, in patients with type 2 diabetes mellitus and hypertension, first-line RAS inhibitors reduced adverse cardiovascular events to the same degree as first-line diuretics but to a greater degree than first-line calcium channel blockers and first-line beta blockers.

Authors+Show Affiliations

Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China.Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China.Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China.Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China. tangwenlu@fudan.edu.cn.Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis

Language

eng

PubMed ID

29713053

Citation

Wang, Ganmi, et al. "First-line Renin-angiotensin System Inhibitors Vs. Other First-line Antihypertensive Drug Classes in Hypertensive Patients With Type 2 Diabetes Mellitus." Journal of Human Hypertension, vol. 32, no. 7, 2018, pp. 494-506.
Wang G, Chen Y, Li L, et al. First-line renin-angiotensin system inhibitors vs. other first-line antihypertensive drug classes in hypertensive patients with type 2 diabetes mellitus. J Hum Hypertens. 2018;32(7):494-506.
Wang, G., Chen, Y., Li, L., Tang, W., & Wright, J. M. (2018). First-line renin-angiotensin system inhibitors vs. other first-line antihypertensive drug classes in hypertensive patients with type 2 diabetes mellitus. Journal of Human Hypertension, 32(7), 494-506. https://doi.org/10.1038/s41371-018-0066-x
Wang G, et al. First-line Renin-angiotensin System Inhibitors Vs. Other First-line Antihypertensive Drug Classes in Hypertensive Patients With Type 2 Diabetes Mellitus. J Hum Hypertens. 2018;32(7):494-506. PubMed PMID: 29713053.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - First-line renin-angiotensin system inhibitors vs. other first-line antihypertensive drug classes in hypertensive patients with type 2 diabetes mellitus. AU - Wang,Ganmi, AU - Chen,Yujie, AU - Li,Liangjin, AU - Tang,Wenlu, AU - Wright,James M, Y1 - 2018/05/01/ PY - 2017/12/31/received PY - 2018/03/27/accepted PY - 2018/03/13/revised PY - 2018/5/2/pubmed PY - 2019/10/23/medline PY - 2018/5/2/entrez SP - 494 EP - 506 JF - Journal of human hypertension JO - J Hum Hypertens VL - 32 IS - 7 N2 - First-line renin-angiotensin system (RAS) inhibitors are recommended for diabetic patients because of their potential nephron-protective properties. For hypertensive patients with type 2 diabetes mellitus, little is known about first-line RAS inhibitors vs. other first-line antihypertensive agents in terms of cardiovascular outcomes. We performed a meta-analysis of randomized controlled trials (RCTs) to assess the comparative efficacy of first-line RAS inhibitors vs. other first-line antihypertensive drug classes in hypertensive patients with type 2 diabetes mellitus. We identified RCTs by searching the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE up to December 15, 2015. Eighteen RCTs involving 18,862 participants were included. First-line RAS inhibitors were not different from first-line diuretics for all the primary outcomes. First-line RAS inhibitors reduced major cardiovascular events (2 RCTs, relative risk [RR] 0.78, 95% confidence interval [CI] 0.66, 0.91) and heart failure (4 RCTs, RR 0.72, 95% CI 0.61, 0.83) compared to first-line calcium channel blockers. Compared to β-blockers, RAS inhibitors reduced the risk of all-cause mortality (1 RCT, RR 0.63, 95% CI 0.47, 0.84), major cardiovascular events (1 RCT, RR 0.76, 95% CI 0.62, 0.93) and heart failure (1 RCT, RR 0.60, 95% CI 0.40, 0.92). Our meta-analysis indicates that, in patients with type 2 diabetes mellitus and hypertension, first-line RAS inhibitors reduced adverse cardiovascular events to the same degree as first-line diuretics but to a greater degree than first-line calcium channel blockers and first-line beta blockers. SN - 1476-5527 UR - https://www.unboundmedicine.com/medline/citation/29713053/First_line_renin_angiotensin_system_inhibitors_vs__other_first_line_antihypertensive_drug_classes_in_hypertensive_patients_with_type_2_diabetes_mellitus_ L2 - https://doi.org/10.1038/s41371-018-0066-x DB - PRIME DP - Unbound Medicine ER -