For patients with diabetes and hypertension, guidelines recommend angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) over other antihypertensives. But few studies have compared the efficacy of these drugs in diabetic patients.
To compare ACE inhibitors with ARBs, researchers carried out a network meta-analysis including data from published and unpublished randomised controlled trials and subgroup data on patients with diabetes from larger trials. The analysis included 103,120 participants.
The team found that ACE inhibitors and ARBs were equivalent with regards to major cardiovascular outcomes and risk of progression to renal disease over a median follow-up of 3.2 years. Combining both treatments did not provide any benefit over monotherapy.
Writing in PLoS Medicine (online, 8 March 2016)
, the researchers say prescribers should weigh up the benefits, costs and potential harms of the drugs for individual patients with diabetes.
 Catala-Lopez F, Macias Saint-Gerons D, Gonzalez-Bermejo D et al. Cardiovascular and renal outcomes of renin–angiotensin system blockade in adult patients with diabetes mellitus: a systematic review with network meta-analyses. PLoS Medicine 2016;13:e1001971. doi: 10.1371/journal.pmed.1001971