Benefit of Renin-Angiotensin-Aldosterone Blockade in Patients with Diabetes Depends on the Drug

Suppressing the renin-angiotensin-aldosterone system in patients with type 2 diabetes is believed to lower cardiovascular (CV)-related and all-cause mortality, but in a recent study, the angiotensin II–receptor blocker (ARB) olmesartan (Benicar) was associated with excess mortality among patients taking the drug versus placebo (NEJM JW Gen Med Mar 17 2011). To assess the separate effects of angiotensin-converting–enzyme (ACE) inhibitors and ARBs on mortality, investigators in China conducted a meta-analysis of 35 randomized, controlled trials (56,000 patients; 23 studies of ACE inhibitors; 13 studies of ARBs) in which various members of each of the two drug classes were compared with various active drugs or placebo.

ACE inhibitors were assoc…