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Renin-angiotensin system blockade has been proven to reduce mortality and morbidity in populations at high risk for cardiovascular events. This extends to the patients with diabetes mellitus, where evidence-based guidelines recommend first -line treatment with ACE inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) in patients with hypertension and/or proteinuria.1 However, few studies have directly compared ACEIs to ARBs in a randomised-controlled trial (RCT) design. Since ACEIs and ARBs antagonise the renin-angiotensin system through different mechanisms, it is possible that their effects on mortality and cardiovascular outcomes may not be identical.
This was a meta-analysis of RCTs that compared different ACEI and ARB regimens in patients with diabetes …