A comparison between angiotensin converting enzyme inhibitors and angiotensin receptor blockers on end stage renal disease and major adverse cardiovascular events in diabetic patients: a population-based dynamic cohort study in Taiwan

Cardiovascular Diabetology

Original Investigation

Jia-Rou Liu¹  Lai-Chu See²  Ming-Shien Wen³  Hsin-Fu Lee³  Yung-Hsin Yeh³  Lung-Sheng Wu³  Shang-Hung Chang³  Wei-Jan Chen³  Yi-Hsin Chan³  Chi-Tai Kuo³  Gwo-Jyh Chang⁴ 

[1] Department of Public Health, College of Medicine, and Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Tao-Yuan, Taiwan;Department of Public Health, College of Medicine, and Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Tao-Yuan, Taiwan;Division of Rheumationalogy and Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan;Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Linkou, Tao-Yuan, Taiwan;Graduate Institute of Clinical Medicinal Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan;

关键词: Angiotensin converting enzyme inhibitors;    Angiotensin receptor blockers;    Diabetes mellitus;    Major adverse cardiovascular events;    End-stage renal disease;   

DOI  :  10.1186/s12933-016-0365-x

 received in 2015-12-24, accepted in 2016-03-10,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundContemporary guidelines recommend angiotensin-converting-enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARB) for hypertensive patients with diabetes. However, there is limited data to evaluate the comparison between ACEi and ARB on end stage renal disease (ESRD) and major adverse cardiovascular events (MACE), in Asian diabetic patients.MethodsWe used the Taiwan Longitudinal Cohort of Diabetes Patients Database to perform a population-based dynamic cohort study. The comparison between ACEi and ARB on ESRD and MACE in diabetic patients was examined using the propensity score weighting method. We followed these patients until the occurrence of first study outcomes or end date of the study, whichever came first.ResultsThere were 6898 and 12,758 patients in ACEi and ARB groups, respectively. The mean follow-up period was about 3.5 years in ESRD and 2.5 years in MACE. The incidence of ESRD was 0.44 % and 0.63 % per person-years in the ACEi and ARB group, respectively. The risk of ESRD was lower in the ACEi group than the ARB group [hazard ratio (HR) 0.69; 95 % confidence interval (CI) 0.54–0.88, P = 0.0025]. Among those without chronic kidney disease (CKD), the incidence of ESRD was 0.30 % and 0.37 % per person-years in the ACEi and ARB group, respectively. ACEi was similar to ARB in preventing ESRD for those without CKD (P = 0.11). Among those with CKD, the incidence of ESRD was 1.39 % and 2.34 % per person-years in the ACEi and ARB group, respectively. The ACEi group had a lower risk of ESRD than the ARB group (HR 0.61; 95 % CI 0.42–0.88, P = 0.008). The incidence of MACE was 9.33 % and 9.62 % per person-years in the ACEi and ARB group, respectively. There was no significant difference in the composite MACE outcome between the two groups (P = 0.42), but the ACEi group was associated with a higher risk of stroke than the ARB group (HR 1.12; 95 % CI 1.02–1.24, P = 0.02).ConclusionsACEi compared with ARB was associated with a lower incidence of ESRD, especially in those with CKD. Though ACEi and ARB had a similar risk of composite MACE outcome, ACEi had a slightly higher incidence of stroke than ARB, among the Asian diabetic patients.

【 授权许可】

CC BY   
© Wu et al. 2016