Background The effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II
Background The effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on cardiovascular (CV) risk in hypertensive patients with type 2 diabetes mellitus (T2 DM) are uncertain. 0.90 [95% confidence intervals (CI): 0.82-0.98] with no heterogeneity (I2?=?19.50%; = 0.275);and 17% reduction in CV mortality, pooled HR of 0.83 [95% CI: 0.72-0.96] with no heterogeneity (I2?=?0.9%; = 0.388). ACE/ARBs was not associated with MI, stroke and all-cause mortality. Conclusions Treatment with ACE/ARBs results in significant reduction in CV events and mortality in hypertensive patients with T2 DM. Electronic supplementary material The online version of this article (doi:10.1186/1471-2261-14-148) contains supplementary material, which is available to authorized users. Background Hypertension and type 2 diabetes (T2 DM) frequently coexist, and patients with this combination are at a higher risk for cardiovascular Xanthiazone IC50 (CV) events than those suffering from hypertension or T2 DM alone [1C3]. Most (60% to 80%) people with T2 DM die of CV complications, and up to 75% of specific CV complications have been attributed to high blood pressure (BP) . The improved treatment of hypertension has been associated with a marked reduction in death and hospitalization from CV disease . The use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), could reduce both CV morbidity and mortality across populations that apart from hypertension [6C8], had other co-morbid conditions. The beneficial effect of ACE inhibitor treatment on all-cause mortality for hypertensive patients was well established in a recent meta-analysis . However, the effect of ACE/ARBs on CV risk in hypertensive patients with T2 DM remains controversial. The Heart Outcomes Prevention Evaluation (HOPE) study showed that treatment with Ramipril reduced cardiovascular Xanthiazone IC50 events in patients with diabetes, out of which 56% were hypertensive . The Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial (FACET) and Captopril Prevention Project (CAPPP) study demonstrated that the ACE inhibitors fosinopril could significantly reduce risk of major vascular events in hypertensive diabetic patients compared with controls [11, 12]. However, other studies like the Irbesartan Diabetic Nephropathy Trial (IDNT) or The Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) trial failed to find such a beneficial effect in hypertensive patients with T2 DM [13, 14]. To our Xanthiazone IC50 best knowledge, there is no meta-analysis or RCT focused on the effect of ACE/ARBs on CV risk in hypertensive patients with T2 DM, although these classes of drug were recommended for these patients by the guidelines of 2013 European Society of Hypertension (ESH) and of the European Rabbit polyclonal to ZNF490 Society of Cardiology (ESC) and the eighth report of Joint National Committee (JNC 8) [15, 16]. However, the evidence derived from papers focused on the Individuals with and without Diabetes Mellitus separately . The objective of the present study is to review randomized clinical trials (RCT) were revising the effect of antihypertensive treatment using ACE/ARBs on incidence of myocardial infarction (MI), stroke, CV events, and all-cause mortality in hypertensive patients with T2 DM. Methods Search strategy and study selection We performed a systematic search of Pubmed and Embase databases through January 2014 for relevant studies performed in hypertensive patients with T2 DM. Subject headings and key words used for the literature search were as follows: 1) mortality, CV diseases, MI and stroke; 2) hypertension and diabetes; 3) angiotensin-converting enzyme inhibitors and angiotensin receptor blockers; 4) RCTs. The titles, abstracts and full-texts were reviewed independently by two reviewers. Xanthiazone IC50 The criteria for eligible studies were as follows: 1) Randomized clinical trials in hypertensive patients with T2 DM comparing active treatment with ACE inhibitors or ARBs with control treatment (placebo, life style changes, active antihypertensive treatment with drugs other than ACEI or ARB); 2) The endpoints were mortality, CV events, MI or stroke; 3) Hazard ratios (HR) were calculated with the corresponding confidence intervals (CI). Following this search, references of published articles were also reviewed. Finally, 10 RCTs were selected, out of them, IDNT data was used in two articles for the analysis of different endpoint events [14, 17] (Figure?1). Figure 1 Flow chart of study selection. Data extraction We collected the following information from each study: first author name or study title, year of publication, country of origin, gender, follow-up period, class of anti-hypertensive drugs, disease outcome, the number of trial.