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Systematic review with meta-analysis
ACE inhibitors are associated with a reduction in all-cause mortality versus angiotensin II receptor blockers in patients with diabetes mellitus
  1. Ziv Harel,
  2. Samuel A Silver
  1. St. Michael's Hospital, University of Toronto, USA
  1. Correspondence to : Dr Ziv Harel, St Michael's Hospital, University of Toronto, 61 Queen Street, 7th floor, Toronto, Canada M5C2T2; harelz{at}

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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 …

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  • Contributors ZH and SAS drafted the manuscript.

  • Competing interests SAS is supported by a Kidney Research Scientist Core Education and National Training Program Post-Doctoral Fellowship.

  • Provenance and peer review Not commissioned; internally peer reviewed.