ArticleCardiovascular diabetology2025
Comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on cardiovascular outcomes in older adults with type 2 diabetes mellitus: a target trial emulation study.
Article in Cardiovascular diabetology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Diet, the protective bridge connecting nutrition and cardiovascular health: A review.Food chemistry: X · 2026Review
- Drug-specific risks of acute kidney injury associated with triple whammy therapy: a nationwide self-controlled case series study in Japan.Journal of pharmaceutical health care and sciences · 2026Article
- Antihypertensive Plants Used by the Anak Dalam Tribe in Jambi, Indonesia: Ethnobotanical Insights and Pharmacological Potential as Alternatives to Conventional Medicine.Drug design, development and therapy · 2026Review
- Impact of Sedentary Time and Physical Function on Health-Related Quality of Life in Hospitalized Patients with Cardiovascular Disease.CJC open · 2025Article
- Expanding the therapeutic frontier: esaxerenone in hypertensive patients with CKD and albuminuria.Hypertension research : official journal of the Japanese Society of Hypertension · 2025Article
- Sun-aged red date vinegar-based beverage: integrated analysis of fermentation, sensory, volatile, and bioactive properties.Food chemistry: X · 2025Article
- Estimating cardiovascular effects of influenza vaccination in older adults: a target trial emulation using proximal causal inference.EClinicalMedicine · 2025Article
- A Letter to the Editor on "Reducing the Risk of Developing Diabetes: The Role of Angiotensin Receptor Blockers and Angiotensin Converting Enzyme Inhibitors in Patients with Hypertension Combined Prediabetes".Journal of clinical hypertension (Greenwich, Conn.) · 2025Article
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Authors and funding
8 authors.
Funding
Abstract
backgroundAngiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are both recommended as first-line antihypertensive agents for patients with diabetes. While pharmacological mechanisms suggest that ACEIs may provide better cardiovascular protection than ARBs, this potential benefit has not been fully established in previous observational studies of patients with diabetes.
methodsAn active-comparator new-user design within target trial emulation framework was implemented using Yinzhou Regional Health Care Database (YRHCD). We compared risks of major cardiovascular events (MACE) between older patients (age ≥ 65 years) with type 2 diabetes mellitus (T2DM) newly exposed to ACEIs and ARBs from January 1, 2010 to May 31, 2023. The primary outcomes were 3-point MACE, including hospitalized myocardial infarction, hospitalized stroke, and all-cause mortality (a proxy for cardiovascular mortality). We also assessed 4-point MACE, which further included hospitalized heart failure. Propensity scores were calculated to balance 44 identified confounders. Marginal structure models were applied to estimate per-protocol hazard ratios.
resultsA total of 18,558 individuals were included, with 1,641 initiating ACEIs and 16,917 initiating ARBs. Their median age was 72 years and 45% were male. The adjusted hazard ratio for ACEIs vs. ARBs was 0.86 (95% confidence interval [CI], 0.68-1.10) for 3-point MACE and 0.83 (95% CI 0.69-0.99) for 4-point MACE. The 1-year absolute risk differences were - 0.30% (95% CI - 1.80-1.21%) for 3-point MACE and - 1.16% (95% CI - 2.97-0.66%) for 4-point MACE. Results were consistent across subgroup analyses (stratified by age, sex, as well as baseline major atherosclerotic cardiovascular disease, heart failure, other antihypertensive therapy, insulin therapy, and calendar year) and sensitivity analyses.
conclusionsAmong older patients with T2DM, the initiation of ACEIs was associated with a trend toward lower risk of MACE compared to ARBs, implying the potential cardiovascular benefits of ACEIs in this population.
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