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Diabetes And Ace Inhibitors

Effects Of Acei/arb In Hypertensive Patients With Type 2 Diabetes Mellitus: A Meta-analysis Of Randomized Controlled Studies

Effects Of Acei/arb In Hypertensive Patients With Type 2 Diabetes Mellitus: A Meta-analysis Of Randomized Controlled Studies

Abstract The effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on cardiovascular (CV) risk in hypertensive patients with type 2 diabetes mellitus (T2 DM) are uncertain. Our objective was to analyze the effects of ACE/ARBs, on the incidence of myocardial infarction, stroke, CV events, and all-cause mortality in hypertensive patients with T2 DM. PubMed and Embase databases were searched through January 2014 to identify studies meeting a priori inclusion criteria and references in the published articles were also reviewed. Two investigators independently extracted the information with either fixed-effect model or random-effect model to assess the effects of ACE/ARBs treatment in hypertensive patients with T2 DM. Ten randomized controlled studies were included with a total of 21,871 participants. Overall, treatment with ACE/ARBs in hypertensive patients with T2 DM was associated with a statistically significant 10% reduction in CV events, pooled hazard ratio (HR) of 0.90 [95% confidence intervals (CI): 0.82-0.98] with no heterogeneity (I2 = 19.50%; P = 0.275);and 17% reduction in CV mortality, pooled HR of 0.83 [95% CI: 0.72-0.96] with no heterogeneity (I2 = 0.9%; P = 0.388). ACE/ARBs was not associated with MI, stroke and all-cause mortality. Treatment with ACE/ARBs results in significant reduction in CV events and mortality in hypertensive patients with T2 DM. Background Hypertension and type 2 diabetes (T2 DM) frequently coexist, and patients with this combination are at a higher risk for cardiovascular (CV) events than those suffering from hypertension or T2 DM alone [1–3]. Most (60% to 80%) people with T2 DM die of CV complications, and up to 75% of specific CV complications have been attributed to high blood pressu Continue reading >>

Using Ace Inhibitors Appropriately

Using Ace Inhibitors Appropriately

When first introduced in 1981, angiotensin-converting enzyme (ACE) inhibitors were indicated only for treatment of refractory hypertension. Since then, they have been shown to reduce morbidity or mortality in congestive heart failure, myocardial infarction, diabetes mellitus, chronic renal insufficiency, and atherosclerotic cardiovascular disease. Pathologies underlying these conditions are, in part, attributable to the renin-angiotensin-aldosterone system. Angiotensin II contributes to endothelial dysfunction, altered renal hemodynamics, and vascular and cardiac hypertrophy. ACE inhibitors attenuate these effects. Clinical outcomes of ACE inhibition include decreases in myocardial infarction (fatal and non-fatal), reinfarction, angina, stroke, end-stage renal disease, and morbidity and mortality associated with heart failure. ACE inhibitors are generally well tolerated and have few contraindications. Cardiovascular disease affects one in four Americans. According to the American Heart Association, heart and related diseases are expected to cost Americans more than $329 billion in 2002. An estimated 10 million persons in this country are known to have diabetes and 3.6 million to have renal disease, incurring annual health care costs of $98 billion and $11 billion, respectively. Although angiotensin-converting enzyme (ACE) inhibitors have documented clinical benefits in a variety of clinical situations, the disparity between the evidence from clinical trials and bedside medicine is well documented. The National Registry of Myocardial Infarction 2 found that fewer than one half of patients surviving acute myocardial infarction who were candidates for therapy with ACE inhibitors received these life-saving drugs at discharge.1 A recent review of patients with asymptomatic l Continue reading >>

Ace Inhibitors

Ace Inhibitors

A class of medicine usually used to treat high blood pressure. Angiotensin-converting enzyme (ACE) inhibitors also appear to protect people with diabetes from diabetic nephropathy (kidney disease). People with diabetes are especially prone to hypertension (defined as a blood pressure level of 140/90 mm Hg or greater). Some 20% to 60% of individuals with diabetes have high blood pressure. Hypertension increases their risk not only of heart disease and stroke, but also of peripheral vascular disease, diabetic retinopathy, diabetic nephropathy, and possibly diabetic neuropathy. The American Diabetes Association (ADA) currently recommends a target blood pressure level of under 130/80 mm Hg in people with diabetes. The ADA recommends a number of different measures for lowering blood pressure, including weight loss, sodium restriction, and exercise. When these measures aren’t enough, the addition of one or more medicines is warranted. There are several different classes of blood pressure drugs, including angiotensin-receptor blockers (ARBs), diuretics, beta blockers, and ACE inhibitors. Overall, drug therapy has been shown to substantially decrease the risk of cardiovascular disease, diabetic retinopathy, and diabetic nephropathy. ACE inhibitors may have a special advantage in terms of slowing the progression of diabetic nephropathy. Research findings show that ACE inhibitors can slow the progression of kidney disease to a greater degree than other antihypertensive drugs that lower blood pressure by a similar amount and that they may be able to protect the kidneys even in people with diabetes whose blood pressure levels are in the normal range. This suggests that ACE inhibitors protect the kidneys by mechanisms other than just blood pressure control. Currently, the ADA reco Continue reading >>

Type 2 Diabetes Mellitus With Angiotensin-converting-enzyme Inhibitors

Type 2 Diabetes Mellitus With Angiotensin-converting-enzyme Inhibitors

Currently, ACE inhibitors and angiotensin II-receptor blockers are recommended to prevent cardiovascular disease and nephropathy in patients with type 2 diabetes.[ 3 , 7 , 26 ] Clinical data from randomized controlled trials have validated the physiological effects of angiotensin II on the pancreas. Though none of the trials involving ACE inhibitors used new-onset diabetes as a primary endpoint and each trial had its own limitations, the reproducibility of the results is encouraging. The Captopril Prevention Project (CAPPP) was a prospective, randomized, open-label trial with a blinded endpoint evaluation.[ 27 ] The objective of this study was to compare cardiovascular morbidity and mortality in hypertensive patients using an ACE inhibitor or conventional antihypertensive treatment, which included diuretics (most commonly hydrochlorothiazide and bendrofluazide) and -blockers (most commonly atenolol and metoprolol). A total of 10,985 patients age 25-66 years with a diastolic blood pressure of 100 mm Hg on two occasions were enrolled and randomly assigned to receive either captopril (50-200 mg daily) or conventional antihypertensive treatment for 6.1 years. New-onset diabetes mellitus, defined per 1985 World Health Organization criteria,[ 28 ] was set as a secondary outcome for this study. At baseline, diabetes was more prevalent in the captopril group (5.6%) than the conventional therapy group (4.8%). However, by the studys end, the prevalence of diabetes mellitus in the captopril-treated group was significantly less than that in the conventional treatment group (RR, 0.86; 95% CI, 0.74-0.99; p = 0.039). Two major concerns noted about the trial were the randomization method and the control medications used. Patients were randomized using a computer-generated number seque Continue reading >>

Ace Inhibitors Improve Diabetic Nephropathy Through Suppression Of Renal Mcp-1

Ace Inhibitors Improve Diabetic Nephropathy Through Suppression Of Renal Mcp-1

OBJECTIVE—Chemokines play an important role in the pathogenesis of diabetic nephropathy. Angiotensin II induces several fibrogenic chemokines, namely monocyte chemoattractant protein-1 (MCP-1) and transforming growth factor-β. The progression of diabetic nephropathy can be retarded by ACE inhibitors (ACEIs) in patients with type 1 and type 2 diabetes. We examined if blockade of the renin-angiotensin system lowered urinary levels of the chemokine MCP-1 and correlated urinary MCP-1 (uMCP-1) with parameters of renal function and glucose and lipid metabolism before and after 1 year of treatment with an ACE inhibitor. RESEARCH DESIGN AND METHODS—In 22 patients with type 2 diabetes and diabetic nephropathy in stages 3–5, treatment with the ACEI lisinopril was initiated. Before treatment and after 12 months of continuous therapy, proteinuria, creatinine clearance, uMCP-1 levels, BMI, HbA1c, and serum cholesterol were assessed. RESULTS—Lisinopril treatment improved renal function. Proteinuria decreased from 410 ± 662 mg per 24 h to 270 ± 389 mg per 24 h. Creatinine clearance rose from 61 ± 26 to 77 ± 41 ml/min. Urinary MCP-1 levels decreased from 0.456 ± 0.22 ng/mg creatinine to 0.08 ± 0.096 ng/mg creatinine. The change in uMCP-1 correlated significantly (r = 0.61, P < 0.001) with the change in proteinuria. No other parameter correlated with the improvement in renal function. CONCLUSIONS—Blockade of the renin-angiotensin system in type 2 diabetic patients with diabetic nephropathy reduces uMCP-1 levels and improves renal function. Because MCP-1 induces monocyte immigration and differentiation to macrophages, which augment extracellular matrix production and tubulointerstitial fibrosis, pharmacological reduction of angiotensin II may also exert its beneficial ef Continue reading >>

Learning About Ace Inhibitors And Arbs For Diabetes

Learning About Ace Inhibitors And Arbs For Diabetes

Learning About ACE Inhibitors and ARBs for Diabetes ACE inhibitors and ARBs are medicines used to control blood pressure. They allow blood vessels to relax and open up. This lowers your blood pressure. When you have diabetes, taking an ACE inhibitor or ARB can help to: Treat high blood pressure. Your risk of problems from diabetes goes up when you have high blood pressure. Prevent or slow kidney damage. Diabetes can damage the blood vessels in the kidneys. High blood pressure can damage the kidneys, too. Lower the risks of stroke and heart attack. Your risks go up when you have high blood pressure, heart disease, or both. An ACE inhibitor or ARB is a good choice for people with diabetes. Unlike some medicines, these don't affect blood sugar levels. Some side effects of ACE inhibitors include: Low blood pressure. You may feel dizzy and weak. An allergic reaction of the skin. Symptoms may range from mild swelling to painful welts. You may have other side effects or reactions not listed here. Check the information that comes with your medicine. Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor or nurse call line if you think you are having a problem with your medicine. Before starting an ACE inhibitor or ARB, tell your doctor if you: These medicines are not safe for pregnancy. If you are pregnant or planning to be, talk to your doctor about a safe blood pressure medicine. ACE inhibitors can cause a dry cough. If the cough is bad, talk to your doctor. Switching to an ARB is likely to help. Taking some medicines together can cause problems. Tell your doctor or pharmacist all the medicines you take. This includes over-the-counter medicines and natural health products. You may need regular blood and urine tests. Go to Enter M316 in the search Continue reading >>

Ace Inhibitors Top Choice For Hypertension In Diabetes

Ace Inhibitors Top Choice For Hypertension In Diabetes

ACE Inhibitors Top Choice for Hypertension in Diabetes As recommended in guidelines, angiotensin-converting enzyme (ACE) inhibitors should be the first-line treatment in patients with hypertension who have diabetes mellitus (DM) when cost is not a concern, according to a new study. In addition, the authors suggest that calcium channel blockers might be the preferred treatment in combination with ACE inhibitors if adequate blood pressure control cannot be achieved by ACE inhibitors alone. Among patients with DM, ACE inhibitors fared better than placebo in reducing creatinine doubling, and beta-blockers were associated with an increased risk of death. In addition, ACE inhibitors in combination with other antihypertension medications did not show significant protective effects compared with placebo, but the likelihood of lowering mortality in patients was greater. Guidelines suggest ACE inhibitors or angiotensin receptor blockers (ARBs) should be the first-line treatment in in patients with hypertension who have DM when cost is not a concern. Clinical trials comparing an ACE inhibitor with an ARB are rare, and the difference in protective effects between these drugs for patients with DM remains inconclusive. No consensus exists about the choice of treatments in combination with renin-angiotensin system blockers in patients with DM, state lead author Hon-Yen Wu and colleagues from National Taiwan University Hospital and College of Medicine, Taipei, Taiwan. By combining direct and indirect evidence, our analyses show the renoprotective effects and superiority of ACE inhibitors in patients with diabetes, and also show the harmful effects of beta-blockers, the authors state. As the available evidence is not able to show a better protective effect for ARBs compared with ACE in Continue reading >>

Effects Of Ras Inhibitors On Diabetic Retinopathy: A Systematic Review And Meta-analysis

Effects Of Ras Inhibitors On Diabetic Retinopathy: A Systematic Review And Meta-analysis

Summary Results of several studies have shown a possible beneficial effect of renin-angiotensin system (RAS) inhibitors on diabetic retinopathy, but the findings were contradictory. We did a systematic review and meta-analysis to assess the effect of RAS inhibitors on diabetic retinopathy. We identified relevant publications in PubMed, Embase, Cochrane Library Central Register of Controlled Trials, and abstracts from main annual meetings. Only randomised controlled trials comparing angiotensin-converting enzyme (ACE) inhibitor or angiotensin-receptor blocker (ARB) monotherapy with other antihypertensive drugs or placebo in type 1 or type 2 diabetes were eligible for inclusion in the analysis. The primary outcomes were progression and regression of diabetic retinopathy in all patients and several subgroups. Risk ratios (RRs) with corresponding 95% CIs were pooled. We also did a network meta-analysis to assess the effect of different antihypertensive drugs on diabetic retinopathy by ranking order. This study is registered with the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42013004548. 21 randomised clinical trials with 13 823 participants were included in the meta-analysis. RAS inhibitors were associated with reduced risk of progression (absolute risk difference −3%, 95% CI −5 to −1; pooled RR 0·87, 95% CI 0·80–0·95; p=0·002) and increased possibility of regression of diabetic retinopathy (8%, 1–16; RR 1·39, 95% CI 1·19–1·61; p=0·00002). In normotensive patients, RAS inhibitors decreased risk of diabetic retinopathy progression (0·81, 0·69–0·94; p=0·007) and increased possibility of regression (1·43, 1·14–1·79; p=0·002). In hypertensive patients, RAS inhibitors were not associated with difference in risk Continue reading >>

Role Of Ace Inhibitors In Treating Hypertensive Diabetic Patients

Role Of Ace Inhibitors In Treating Hypertensive Diabetic Patients

, Volume 2, Issue3 , pp 251257 | Cite as Role of ACE Inhibitors in treating hypertensive diabetic patients Cardiovascular disease (CVD) is a major determining factor of morbidity and mortality in type 2 diabetic patients. Hypertension, which accompanies diabetes in more than 70% of cases, contributes to increased prevalence of CVD events in this group of patients. Results from the United Kingdom Prospective Diabetes Study (UKPDS) indicated that reduction of elevated blood pressure might decrease CVD morbidity and mortality more than reduction of hyperglycemia. Activation of circulating and tissue renin-angiotensin system (RAS) contributes to the development of both hypertension and insulin resistance in patients with the cardiometabolic syndrome. Angiotensin-converting enzyme (ACE) inhibitor therapy in patients with the cardio-metabolic syndrome may improve insulin action as well as lessen CVD. In clinical trials, ACE inhibitors have been shown to be more efficient than other antihypertensive medications (ie, calcium channel blockers) in the reduction of CVD morbidity and mortality in hypertensive diabetics. In this article, we summarize possible mechanisms by which ACE inhibition may improve insulin resistance, coagulation/ clotting, and vascular function abnormalities, and postpone or even prevent the development of type 2 diabetes in hypertensive patients. RamiprilFosinoprilUnited Kingdom Prospective Diabetes StudyImidaprilHypertension Optimal Treatment These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves. This is a preview of subscription content, log in to check access Unable to display preview. Download preview PDF. Sowers JR, Epstein M, Frohlich ED: Hypertensi Continue reading >>

Role Of Ace Inhibitors In Patients With Diabetes Mellitus.

Role Of Ace Inhibitors In Patients With Diabetes Mellitus.

Abstract The adjective 'epidemic' is now attributed to the rapidly growing number of patients with diabetes mellitus, mainly type 2. and the specific complications linked to this disorder. Provided they are recognised early enough, these different complications can be treated; in some patients the evolutive course of these complications can be slowed or even stopped. Furthermore, some recent observations suggest that specific tissular lesions may be prevented or even reversed. Although glycaemic control is essential, other therapeutic measures that must also be taken include those to control blood pressure and to lower lipid levels. Of the agents available to control the complications of diabetes mellitus, cardiovascular drugs, and particularly ACE inhibitors, have a pre-eminent place. Experimental and epidemiological data suggest that activation of the renin-angiotensin-aldosterone system plays an important role in increasing in the micro- and macrovascular complications in patients with diabetes mellitus. Not only are ACE inhibitors potent antihypertensive agents but there is a growing body of data indicating that also they have a specific 'organ-protective' effect. For the same degree of blood pressure control, compared with other antihypertensive agents, ACE inhibitors demonstrate function and tissue protection of considered organs. ACE inhibitors have been reported to improve kidney, heart, and to a lesser extent, eye and peripheral nerve function of patients with diabetes mellitus. These favourable effects are the result of inhibition of both haemodynamic and tissular effects of angiotensin II. Finally, there are a growing number of arguments favouring the use of ACE inhibitors very early in patients with diabetes mellitus. Continue reading >>

Ace Inhibitor

Ace Inhibitor

Not to be confused with Acetylcholinesterase inhibitor. An angiotensin-converting-enzyme inhibitor (ACE inhibitor) is a pharmaceutical drug used primarily for the treatment of hypertension (elevated blood pressure) and congestive heart failure. This group of drugs causes relaxation of blood vessels as well as a decrease in blood volume, which leads to lower blood pressure and decreased oxygen demand from the heart. They inhibit the angiotensin-converting enzyme, an important component of the renin–angiotensin system. Frequently prescribed ACE inhibitors include benazepril, zofenopril, perindopril, trandolapril, captopril, enalapril, lisinopril, and ramipril. Medical use[edit] ACE inhibitors were initially approved for the treatment of hypertension and can be used alone or in combination with other antihypertensive medications. Later, they were found useful for other cardiovascular and kidney diseases[1] including: Acute myocardial infarction (heart attack) Cardiac failure (left ventricular systolic dysfunction) Kidney complications of diabetes mellitus (diabetic nephropathy) In treating heart disease, ACE inhibitors are usually used with other medications. A typical treatment plan often includes an ACE inhibitor, a beta blocker, a long-acting nitrate, and a calcium channel blocker, in combinations that are adjusted to the individual patient's needs. There are fixed-dose combination drugs, such as ACE inhibitor and thiazide combinations. ACE inhibitors have also been used in chronic kidney failure and kidney involvement in systemic sclerosis (hardening of tissues, as scleroderma renal crisis). In those with stable coronary artery disease, but no heart failure, benefits are similar to other usual treatments.[2] Other[edit] ACE inhibitors may also be used to help decreas Continue reading >>

Should All Patients With Type 1 Diabetes Mellitus And Microalbuminuria Receive Angiotensin-converting Enzyme Inhibitors?: A Meta-analysis Of Individual Patient Data

Should All Patients With Type 1 Diabetes Mellitus And Microalbuminuria Receive Angiotensin-converting Enzyme Inhibitors?: A Meta-analysis Of Individual Patient Data

Purpose: To determine whether response of albumin excretion rate to angiotensin-converting enzyme (ACE) inhibitors has a threshold in patients with type 1 diabetes mellitus and microalbuminuria and to examine treatment effect according to covariates. Study Selection: Selected studies included at least 10 normotensive patients with type 1 diabetes mellitus and microalbuminuria, had a placebo or nonintervention group, and included at least 1 year of follow-up. Data Extraction: Raw data were obtained for 698 patients from the 12 identified trials. Analysis of treatment effect at 2 years was restricted to trials with at least 2 years of follow-up (646 patients from 10 trials). Data Synthesis: In patients receiving ACE inhibitors, progression to macroalbuminuria was reduced (odds ratio, 0.38 [95% CI, 0.25 to 0.57]) and the odds ratio for regression to normoalbuminuria was 3.07 (CI, 2.15 to 4.44). At 2 years, albumin excretion rate was 50.5% (CI, 29.2% to 65.5%) lower in treated patients than in those receiving placebo (P�<�0.001). Estimated treatment effect varied by baseline albumin excretion rate (74.1% and 17.8% in patients with a rate of 200 µg/min and 20 µg/min, respectively [P�=�0.04]) but not by patient subgroup. Adjustment for change in blood pressure attenuated the treatment difference in albumin excretion rate at 2 years to 45.1% (CI, 18.6% to 63.1%; P�<�0.001). Conclusions: In normotensive patients with type 1 diabetes mellitus and microalbuminuria, ACE inhibitors significantly reduced progression to macroalbuminuria and increased chances of regression. Beneficial effects were weaker at the lowest levels of microalbuminuria but did not differ according to other baseline risk factors. Changes in blood pressure cannot entirely explain Continue reading >>

The Use Of Ace Inhibitors

The Use Of Ace Inhibitors

The Kidneys and Diabetes Back to Related Health Issues ACE inhibitors, are drugs normally used for the treatment of high blood pressure. This is a category of drugs called Angio-Converting Enzyme inhibitors – ACE for short. ACE is an enzyme found in our bodies which activates a hormone called angiotensin causing the blood vessels to constrict, so raising blood pressure and putting pressure on the heart. ACE inhibitors prevent the action of angiotensin resulting in a lowering of blood pressure. However, there is evidence that the use of ACE inhibitors in people who start to show small amounts of protein in the urine, helps to reduce the progression to macroalbuminuria. In other words the use of ACE inhibitors has a protective effect on the kidneys, even in people whose blood pressure is normal. What does the research show? A meta-analysis [Ann Intern Med 2001 March ; 134[5] 370-9] was published on this subject. This is an analysis of studies to provide better evidence than just looking at individual studies. In this case, the studies were selected on the following basis: They included at least 10 people with Type 1 diabetes who had microalbuminuria and normal blood pressure. They had a control group who were not treated with ACE inhibitors [placebo group] They had follow up results at least a year later. 12 studies were selected with a total of 698 patients. The results showed: The progression to macroalbuminuria was reduced in patients receiving ACE inhibitors. After two years the albumin excretion rate was 50.5% lower in treated patients than in those receiving a placebo [no treatment]. For patients with normal blood pressure, Type 1 diabetes and microabluminuria, ACE inhibitors significantly reduced progression to macroalbuminuria and also increased the chances of r Continue reading >>

Ace Inhibitors (side Effects, List Of Names, Uses, And Dosage)

Ace Inhibitors (side Effects, List Of Names, Uses, And Dosage)

What are ACE inhibitors, and how do they work (mechanism of action)? Angiotensin II is a very potent chemical produced by the body that primarily circulates in the blood. It causes the muscles surrounding blood vessels to contract, thereby narrowing the vessels. The narrowing of the vessels increases the pressure within the vessels causing increases in blood pressure (hypertension). Angiotensin II is formed from angiotensin I in the blood by the enzyme angiotensin converting enzyme (ACE). (Angiotensin I in the blood is itself formed from angiotensinogen, a protein produced by the liver and released into the blood.) Angiotensin converting enzyme inhibitors (ACE inhibitors) are medications that slow (inhibit) the activity of the enzyme ACE, which decreases the production of angiotensin II. As a result, blood vessels enlarge or dilate, and blood pressure is reduced. This lower blood pressure makes it easier for the heart to pump blood and can improve the function of a failing heart. In addition, the progression of kidney disease due to high blood pressure or diabetes is slowed. Why are ACE inhibitors prescribed (uses)? ACE inhibitors are used for: ACE inhibitors also improve survival after heart attacks. In studies, individuals with hypertension, heart failure, or prior heart attacks who were treated with an ACE inhibitor lived longer than patients who did not take an ACE inhibitor. ACE inhibitors are an important group of drugs because they prevent early death resulting from hypertension, heart failure or heart attacks. Some individuals with hypertension do not respond sufficiently to ACE inhibitors alone. In these cases, other drugs often are used in combination with ACE inhibitors. List of examples of brand and generic drug names for ACE inhibitors The following is a li Continue reading >>

Ace-inhibitors And New-onset Diabetes

Ace-inhibitors And New-onset Diabetes

1 - Epidemiology Type 2 diabetes is a major risk factor for cardiovascular mortality and morbidity. The prevalence of diabetes is increasing worldwide causing tremendous social economic burden to patients and health care providers. Effective strategies for the prevention of diabetes include diet and exercise in order to reduce insulin-resistant fatty tissue and improve insulin sensitivity 1. Randomised trials have convincingly demonstrated that lifestyle changes are associated with a convincing reduction in the progression to diabetes 1. However, the implementation of lifestyle modifications is challenging and therefore, new strategies for the prevention of diabetes are warranted. 2 - Preventive Treatment Peroxisome-proliferator-activated receptor (PPAR) agonists which are known to improve insulin sensitivity and metformin have been shown to reduce the incidence of diabetes 2. In addition, various clinical trials in more than 66,608 patients with coronary artery disease, hypertension, or heart failure have demonstrated a delay and/or prevention of new-onset diabetes with substances directed to inhibit the renin-angiotensin system (RAS) 3-6. However, in all these studies, the incidence of diabetes was not the primary endpoint and in most of the studies results were obtained from post-hoc analyses. In addition, glucose levels were not systematically reviewed. Since inhibition of the RAS is an effective and widely used method for reducing mortality and morbidity in patients with cardiovascular disease, additional positive effects on plasma glucose levels would be intriguing. 3 - The Dream Trial In order to further elucidate the effect of inhibitors of the RAS and the incidence of diabetes the Diabetes Reduction Assessment of Ramipril and Rosiglitazone Medications (DREAM) t Continue reading >>

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