ACE inhibitors and calcium channel blockers: patterns of use and associations with mortality in type 1 diabetes

Diabetes Res Clin Pract. 2004 Jul;65(1):37-43. doi: 10.1016/j.diabres.2003.11.017.

Abstract

Objective: To determine the frequency of ACE-I and Calcium channel blockers (CCB) use in type 1 diabetes (T1D), and associations of these medications with mortality.

Research design and methods: Data from the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study, a 10-year follow up of childhood onset T1D, were used to document ACE-I and CCB use. Use in subjects who died during follow up was compared to gender, age, duration (+/-5 years), hypertension, and renal status matched living controls.

Results: ACE-I use increased from baseline (1986-1988) to 10 years later (1996-1998) for those with hypertension (20.8-65.8%), and microalbuminuria (2.3-31.5%). However, the majority of patients with microalbuminuria were not on ACE-I at 10 years. CCB use was 2.1% at baseline, increased to 10.4% at 8 years, and fell to 9.5% at 10 years. An increased risk of mortality was apparent for those not treated with either ACE-I or CCB when controlling for cardiovascular status and age (hazard ratio (HR) 2.6, 95% CI 1.1-6.3), while ACE-I use alone was protective (HR=0.26, 0.08-0.79). CCB use with or without ACE-I was not related to mortality status.

Conclusions: This data suggests that ACE-I use is not optimal, but more favorably associated with decreased mortality than CCB use.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Albuminuria / drug therapy
  • Angiotensin-Converting Enzyme Inhibitors / pharmacology*
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Antihypertensive Agents / pharmacology
  • Antihypertensive Agents / therapeutic use
  • Calcium Channel Blockers / pharmacology*
  • Calcium Channel Blockers / therapeutic use
  • Case-Control Studies
  • Cohort Studies
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 1 / mortality
  • Diabetic Nephropathies / mortality
  • Diabetic Nephropathies / prevention & control
  • Drug Therapy / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / drug therapy
  • Male

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Calcium Channel Blockers