Which blood pressure lowering drug better protects the heart after a heart attack in patients with diabetes?

The aim of this study was to compare the effectiveness of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARBs) in protecting the heart in patients with diabetes that have had a heart attack and who had stents placed. The main finding of the study was that ACEI reduced the risk of major adverse cardiac events in patients with diabetes.

Heart disease is a common complication of diabetes (DM). Heart disease can result in a heart attack (a blockage in the arteries to the heart that reduces the oxygen supply of the heart. One treatment option is to insert stents (tiny mesh tubes) into the arteries of the heart. This keeps them open and allows more oxygen to reach the heart muscle.

Patients with DM who have had a heart attack are at high risk for further heart attacks. Lowering blood pressure is an important part of decreasing risk of cardiovascular events. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) are two different types of drugs that both lower blood pressure. It is unknown which, if either, have better protective effects on the heart in patients with DM who have had a heart attack and had stents placed.

This study included 3,426 patients with DM who had a heart attack and had stents. Patients were then treated with either an ACEI or an ARB. The patients were followed for 2 years.

After 2 years, there was no difference in the number of deaths or further heart attacks between the two groups. However, the ACEI group had a lower requirement for further procedures to increase blood flow to the heart (revascularization) and a lower rate of overall cardiovascular events (heart attacks, strokes, and death due to either of these). In particular, ACEI had a more beneficial effect on the heart in patients that were younger than 75 years, female and had high blood pressure.

The authors concluded that there was no difference in the rates of further heart attacks or death between ACEIs and ARBs. However, they suggested that ACEI reduced the number of cardiovascular events and the need for further revascularization procedures.

The follow-up period was quite short. Longer-term studies are required for more concrete evidence.