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Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and the risk of major adverse cardiac events in patients with diabetes and prior stroke
- Source :
- Journal of Hypertension. 34:567-575
- Publication Year :
- 2016
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2016.
-
Abstract
- Renin-angiotensin-aldosterone system blockers are the preferred antihypertensive medications in patients with diabetes and prior stroke. This study aimed to compare the effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in terms of major adverse cardiac events (MACEs) in patients with diabetes who survived ischemic stroke.We conducted an observational, nationwide, propensity score-matched cohort study using Taiwan's National Health Insurance Research Database. Patients aged at least 20 years with type 2 diabetes who initiated ACEI (n = 15,959) or ARB (n = 23,929) use within 90 days after discharge for first ischemic stroke between January 2000 and December 2011 were allocated to ACEI and ARB groups, respectively. The primary outcomes were MACEs (myocardial infarction, ischemic stroke, and cardiovascular mortality). The secondary outcomes were hospitalization for acute kidney injury and hyperkalemia. Intention-to-treat and as-treated models were used.Intention-to-treat analysis showed no significant difference between the ACEI and ARB groups in the outcomes of MACEs [hazard ratio (HR), 0.99; 95% confidence interval (CI), 0.95-1.04], including ischemic stroke (HR, 1.01; 95% CI, 0.97-1.06), myocardial infarction (HR, 1.06; 95% CI, 0.95-1.18), and cardiovascular mortality (HR, 0.98; 95% CI, 0.91-1.06). As-treated analysis produced similar results. Additionally, the groups showed no difference in the risk of hospitalization for acute kidney injury or hyperkalemia.Our study supports the hypothesis that the risks of MACEs and two additional secondary outcomes in patients with diabetes who survived ischemic stroke did not differ according to ACEI versus ARB use.
- Subjects :
- Male
Risk
medicine.medical_specialty
Databases, Factual
Hyperkalemia
Physiology
Myocardial Infarction
Taiwan
Angiotensin-Converting Enzyme Inhibitors
Comorbidity
030204 cardiovascular system & hematology
Cohort Studies
Angiotensin Receptor Antagonists
03 medical and health sciences
0302 clinical medicine
Diabetes mellitus
Internal medicine
Internal Medicine
medicine
Humans
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Stroke
Aged
Proportional Hazards Models
biology
business.industry
Acute kidney injury
Angiotensin-converting enzyme
Acute Kidney Injury
Middle Aged
medicine.disease
Intention to Treat Analysis
Hospitalization
Diabetes Mellitus, Type 2
Cardiovascular Diseases
Hypertension
biology.protein
Cardiology
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 02636352
- Volume :
- 34
- Database :
- OpenAIRE
- Journal :
- Journal of Hypertension
- Accession number :
- edsair.doi.dedup.....9e5b79a7e48ea5c585f2cbfa5063779a