The Comparative Effectiveness of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers in Patients With Diabetes

The evidence examining the effect of angiotensin‐converting enzyme ( ACE ) inhibitors and angiotensin receptor blockers ( ARB s) on mortality in high‐risk patients is conflicting. To further examine this controversy, the authors compared outcomes between ACE inhibitors and ARB s in a large clinical diabetes registry. A retrospective cohort of 87,472 incident users followed for 105,702 patient‐years was analyzed. Average age was 53.1±10.1 years, 54.2% were men, and 14.4% had cardiovascular disease. All‐cause hospitalization or all‐cause mortality, the composite primary endpoint, occurred in 10,943 (12.5%) patients. Compared with ACE inhibitors, the adjusted hazard for ARB s was 0.90 (95% confidence interval, 0.87–0.94) for all‐cause hospitalization or mortality; 0.95 (0.65–1.40) for mortality; 0.90 (0.87–0.94) for all‐cause hospitalization; and 0.81 (0.74–0.89) for cardiovascular admission. ARB use was associated with a reduced, not increased, risk of hospitalization/mortality relative to ACE inhibition. This was driven by lower hospitalization, with a null mortality result.