Blood Pressure Rx Cuts Heart Attack, Death Rate

Diabetes patients with high blood pressure lower cardiovascular risks with ACE inhibitors

(RxWiki News) Diabetes increases the likelihood of having heart disease. While blood pressure medications may help reduce related risks, some therapies may be more effective than others.

Among those with diabetes, the death rate from heart disease is two to four times greater than for those without diabetes. Two antihypertensive (blood pressure-lowering) therapies—angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs)—are commonly used to lower this risk.

A new study has found that ACE inhibitors may effectively reduce the likelihood of heart attack and death among these individuals while ARBs may not influence these outcomes.

"Discuss benefits of different blood pressure medications with a physician."

Jun Cheng, MD, of the Medical School of Zhejiang University, China, and colleagues evaluated the results from 35 investigations examining the effectiveness of either ACE inhibitors or ARBs on diabetes patients.

ACE inhibitors reduce the production of angiotensin, a hormone that causes the blood vessels to contract and raise blood pressure. ARBs block the effects of the hormone angiotensin II. This hormone can cause blood vessels to narrow and trigger a reaction where the body retains more water, which makes blood pressure go up.

Scientists assessed 23 clinical trials with 32,827 patients comparing the effect of ACE inhibitors with placebo or other active drugs. They reviewed 13 separate studies with 23,867 patients comparing ARBs with no therapy.

After analyzing all results, the authors calculated that ACE inhibitors cut the risk of death from all causes by 13 percent. This type of medication also brought down the odds of cardiovascular death by 17 percent and dropped the likelihood of all major cardiovascular events by 14 percent.

Looking closer at cardiovascular events, the researchers noted a reduced heart attack risk of 21 percent and a lower heart failure risk of 19 percent for ACE inhibitor-takers compared to those not taking this medication.

On the other hand, investigators found that ARBs did not affect death by any cause, heart-related death rate or major cardiovascular events, except for heart failure. ARBs cut heart failure risk by 30 percent.

Neither medication appeared to affect stroke risk.

“ACE inhibitors should be considered as first-line therapy to limit the excess mortality and morbidity in this population,” concluded the authors.

The study was published online March 31 in JAMA Internal Medicine, corresponding with a presentation at the 2014 American College of Cardiology Scientific Sessions.

Review Date: 
March 31, 2014