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European Society of Cardiology meeting, Amsterdam 2013

European Society of Cardiology meeting, Amsterdam 2013. Impact of Angiotensin Converting Enzyme Inhibitor versus Angiotensin Receptor Blocker on Development of Glucose Intolerance and New-onset Diabetes Mellitus in Asian Population.

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European Society of Cardiology meeting, Amsterdam 2013

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  1. European Society of Cardiology meeting, Amsterdam 2013 Impact of Angiotensin Converting Enzyme Inhibitor versus Angiotensin Receptor Blocker on Development of Glucose Intolerance and New-onset Diabetes Mellitus in Asian Population Ji Young Park1, Seung-Woon Rha2, ByoungGeol Choi2, Jae Woong Choi1, Sung Kee Ryu1, CheolUng Choi2, Dong Joo Oh2 1: Cardiology Department, Eulji University, Eulji General Hospital, Seoul, Korea 2: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea European Heart Journal (2013) 34 (Abstract Supplement), 336 and 817.

  2. Background • RAAS and Angiotensin II are activated in the insulin-resistant state, and RAAS inhibition has effects on insulin action and secretion • A meta-analysis1 of randomized controlled trials in patients with hypertension or chronic heart failure showed 22% risk reduction of new-onset diabetes mellitus (NODM) with ACE inhibitor/ARB therapy after mean follow-up of 4.5 years. • By both reducing angiotensin II production and preserving bradykinin, ACE inhibitors have the advantage of further promoting vasodilation allowing maximal perfusion of insulin into tissues and favoring its release from the pancreas. • However, there were limited data to compare the protective effect of ACE inhibitors versus ARBs on the development of NODM. 1. Sheen AJ Diab Metab 2004

  3. Objectives of the study • To evaluate the impact of hypertension on the development of new-onset diabetes (NODM) in the Asian population • To compare the protective effect of ACE inhibitors versus ARBs on development of NODM in the Asian population.

  4. Methods • 4071 patients with no diabetesatbaselinewereincluded for the first objective of the study to assess the linkbetween hypertension and NODM for a follow-up of 5 years. • 1856 patients usingeitherACE inhibitorsor ARBsweremonitored for the secondary objective. Propensity score matchingyieldedtwo groups of respectively 321 patients withequivalentbaselinecharacteristics • Primary end point: cumulative incidence of new-onset diabetes mellitus (NODM). • NODM is defined as having a fasting blood glucose ≥126 or HbA1c ≥6.5%. • Mean follow-up duration was 970 ± 288days after adjustment for both treatment groups.

  5. Cumulative Incidence of NODM depending on hypertension status

  6. Cumulative incidence of NODM with antihypertensive treatment ARBs ACE inhibitors

  7. Conclusion • Hypertension was associated with an increased risk of developing NODM. • In this study, the incidence of NODM was higher in the ARB group as compared with the ACE inhibitor group. • Therefore, ACE inhibitors could be more effective than ARBs in preventing NODM

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