Ramipril Lowers Diabetes Risk Among African Americans With Hypertensive Kidney D

Ramipril Lowers Diabetes Risk Among African Americans With Hypertensive Kidney Disease

Compared with metoprolol and amlodipine, ramipril treatment is associated with a lower risk of developing type 2 diabetes in African American patients with hypertensive kidney disease. Dr. Denyse Thornley-Brown, from the University of Alabama at Birmingham stated that, "Based on our data showing the metabolic and renal benefits of ACE inhibitors, I would recommend ACE inhibitors as the first line of treatment for African Americans with chronic kidney disease secondary to hypertension."

Dr. Thornley-Brown and colleagues used data from the African American Study of Kidney Disease and Hypertension (AASK) to evaluate the association of an angiotensin-converting enzyme inhibitor (ramipril), a beta-blocker (metoprolol), and a calcium channel blocker (amlodipine) with the development of type 2 diabetes and the composite outcome of impaired fasting glucose or diabetes.

Type 2 diabetes developed only about half as often in patients treated with ramipril, compared with patients treated with either metoprolol or amlodipine, the authors report.

Similarly, patients randomized to ramipril treatment were 36% less likely than patients randomized to metoprolol to develop impaired fasting glucose/diabetes, the results indicate. Ramipril-treated patients were 24% less likely than amlodipine-treated patients to reach the composite outcome of impaired fasting glucose/diabetes.

Fasting serum glucose levels at the end of year one and averaged over years one through three were significantly lower in the ramipril-treated group than in the metoprolol-treated group or in the amlodipine-treated group, the researchers note.
The risk of developing diabetes was lower among women than men, the report indicates, and higher among obese patients than among patients with a body mass index below 25.

"Based on our data, ACE inhibitors are an important component of anti-hypertensive treatment in patients with chronic kidney disease secondary to hypertension," Dr. Thornley-Brown concluded. "Since our studies were not designed to look at African Americans with normal renal function or with other causes of renal disease, we cannot generalize our recommendations to include all hypertensive African Americans."
Arch Intern Med 2006;166:797-805.

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