Angiotensin-converting enzyme inhibitors versus angiotensin II receptor blockers on insulin sensitivity in hypertensive patients: A meta-analysis of randomized controlled trials

Abstract

Introduction This meta-analysis aimed to summarize the available evidence to compare angiotensin-converting enzyme (ACE) inhibitors with angiotensin II receptor blockers (ARBs) on improving insulin sensitivity in hypertensive patients. Methods Randomized controlled trials (RCTs) comparing ACE inhibitors versus ARBs published with outcomes on homeostasis model assessment of IR (HOMA-IR), glucose infusion rate (GIR), the quantitative insulin sensitivity check index (QUICKI), insulin sensitivity index (ISI) composite, fasting plasma glucose (FPG), fasting plasma insulin (FPI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were searched through 5 databases. Data were searched from their inception to July 5, 2020. Stata 14.0 was used to perform the meta-analysis. Results Eleven RCTs (n = 1015) were included in this meta-analysis. Pooled analysis of studies showed no significant difference in HOMA-IR between ARBs and ACE inhibitors (WMD = -0.09, 95% CI: -0.69 to 0.50, P = 0.755); however, subgroup analysis of therapeutic duration showed a significant difference in HOMA-IR between ARBs and ACE inhibitors among the long-term intervention subgroup (>12 weeks) (WMD = 0.41, 95% CI: 0.06 to 0.76, P = 0.022) and hypertensive patients with diabetes mellitus subgroup (WMD = 0.55, 95% CI: 0.49 to 0.61, P < 0.001); results showed no significant difference between ARBs and ACE inhibitors on QUICKI score (WMD = -0.00, 95% CI: -0.03 to 0.03, P = 0.953) in hypertensive patients; however, the efficacy of ACE inhibitors on improving GIR and ISI composite was significantly better than that of ARBs (WMD = -1.09, 95% CI: -1.34 to -0.85, P < 0.001; WMD = -0.80, 95% CI: -1.24 to -0.36, P < 0.001, respectively). Furthermore, no significant differences were noted on FPG (WMD = 0.72, 95% CI: -1.39 to 2.83, P = 0.505), FPI (WMD = -0.48, 95% CI: -1.60 to 0.64, P = 0.398), SBP (WMD = -0.65, 95% CI: -1.76 to 0.46, P = 0.254), and DBP (WMD = -0.30, 95% CI: -1.70 to 1.10, P = 0.675) between ARBs and ACE inhibitors. Conclusion Results from this meta-analysis showed that ACE inhibitors resulted in more effective improvement of HOMA-IR compared with ARBs among the long-term intervention and hypertensive patients with DM subgroup; furthermore, the efficacy of ACE inhibitors on improving GIR and ISI composite was significantly better than that of ARBs in hypertensive patients. However, ARBs had no significant difference in QUICKI score, FPG, FPI, SBP, and DBP compared with ACE inhibitors. Larger and better-designed studies are needed to further verify this conclusion.

An overview of the effects of combination therapy with a renin-angiotensin system blocker plus a calcium channel blocker on glucose homeostasis in non-diabetic hypertensive patients

“…Similarly, in a meta-analysis (n=1,015), ACEi were superior on HOMA-IR improvement vs. ARBs in the long-term intervention subgroup of patients (mean difference: 0.41, CI: [0.06, 0.76]; p=0.022) 53 .…”

Clinical Features of Diabetes Mellitus on Rheumatoid Arthritis: Data from the Cardiovascular Obesity and Rheumatic DISease (CORDIS) Study Group

“…Moreover, RA patients also took glucocorticoids significantly more frequently, above all if non-diabetic. As is known, chronic glucocorticoid use may increase the risk of developing both hypertension and diabetes [ 45 ], and some anti-hypertensive agents can also improve glucose metabolism [ 46 , 47 ]. Comorbidities may have an impact on how patients with RA are managed and eventually their quality of life, which emphasizes the value of a customized therapeutic approach [ 48 , 49 ].…”

Is It Still Relevant to Discover New ACE Inhibitors from Natural Products? YES, but Only with Comprehensive Approaches to Address the Patients’ Real Problems: Chronic Dry Cough and Angioedema

“…In reflection of high mortality and morbidity, ACE inhibitors were superior to ARBs in patients with high blood pressure and type 2 diabetes mellitus [10]. In another meta-analysis published in PLoS One, it was shown that ACE inhibitors give rise to a more potent improvement of the homeostasis model assessment of insulin resistance (HOMA-IR) in comparison with ARBs among the long-term intervention and high blood pressure patients with diabetes mellitus subgroup [11]. Although ARBs have a good safety profile, ACE inhibitors have additional benefits when it comes to the management of diabetic patients with high blood pressure.…”