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Diabetes and CVD risk during angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker treatment in hypertension: a study of 15 990 patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
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2014 (English)In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 28, no 11, 663-669 p.Article in journal (Refereed) Published
Abstract [en]

Differences in clinical effectiveness between angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) in the primary treatment of hypertension are unknown. The aim of this retrospective cohort study was to assess the prevention of type 2 diabetes and cardiovascular disease (CVD) in patients treated with ARBs or ACEis. Patients initiated on enalapril or candesartan treatment in 71 Swedish primary care centers between 1999 and 2007 were included. Medical records data were extracted and linked with nationwide hospital discharge and cause of death registers. The 11 725 patients initiated on enalapril and 4265 on candesartan had similar baseline characteristics. During a mean follow-up of 1.84 years, 36 482 patient-years, the risk of new diabetes onset was lower in the candesartan group (hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.69-0.96, P = 0.01) compared with the enalapril group. No difference between the groups was observed in CVD risk (HR 0.99, 95% CI 0.87-1.13, P = 0.86). More patients discontinued treatment in the enalapril group (38.1%) vs the candesartan group (27.2%). In a clinical setting, patients initiated on candesartan treatment had a lower risk of new-onset type 2 diabetes and lower rates of drug discontinuation compared with patients initiated on enalapril. No differences in CVD risk were observed.

Place, publisher, year, edition, pages
2014. Vol. 28, no 11, 663-669 p.
National Category
Cardiac and Cardiovascular Systems
URN: urn:nbn:se:uu:diva-237289DOI: 10.1038/jhh.2014.43ISI: 000343661500003PubMedID: 25211055OAI: oai:DiVA.org:uu-237289DiVA: diva2:768356
Available from: 2014-12-03 Created: 2014-12-01 Last updated: 2016-01-18Bibliographically approved

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Stålhammar, JanSundström, Johan
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