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Angiotensin-converting enzyme inhibitors (ACEIs) reduce all-cause mortality, cardiovascular (CV) deaths and major CV events in patients with diabetes, a new meta-analysis reports.

The meta-analysis included 23 studies comparing ACEIs with placebo or active drugs (32,827 patients) and 13 comparing angiotensin II receptor blockers (ARBs) with no therapy (23,867 patients).

Compared with controls, ACEIs significantly reduced the risk of all-cause mortality by 13 per cent, CV deaths by 17 per cent and major CV events by 14 per cent. Specifically, ACEIs reduced the risk of myocardial infarction by 21 per cent and heart failure by 19 per cent.

ARBs did not significantly influence all-cause mortality, CV death or major CV events – except for a 30 per cent reduction in heart failure. Neither ACEIs nor ARBs reduced stroke risk. ACEI benefits on all-cause and CV mortality did not depend on baseline blood pressure and proteinuria or the type of ACEI.

The authors concluded that “ACEIs should be considered as first-line therapy to limit excess mortality and morbidity” in people with diabetes. (JAMA Intern Med).