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Thouht this was interesting !!!!

Joe




ACE Inhibitor Preferable To Calcium-Channel Blocker In Diabetes

WESTPORT, Mar 05 (Reuters) - The incidence of fatal and nonfatal
myocardial infarction is higher in hypertensive patients with
non-insulin dependent diabetes who are treated with a dihydropyridine
calcium channel blocker than in those treated with an ACE inhibitor.
That finding is reported in the March 5th issue of The New England
Journal of Medicine.

Dr. Raymond O. Estacio of the University of Colorado Health Sciences
Center and colleagues there and elsewhere in Denver report on their
preliminary analysis of secondary end points in the Appropriate Blood
Pressure Control in Diabetes (ABCD) Trial. The study, intended to
compare the effects of moderate versus intensive blood pressure
control on development of diabetic complications, assigned patients
with diabetes to nisoldipine or enalapril treatment. The trial's
monitoring committee recommended termination of nisoldipine treatment
in the hypertensive subgroup based on 5-year data, according to the
report

Among the hypertensive patients, blood pressure control, glucose and
lipid concentrations and smoking behavior over the 5 years were
similar between the nisoldipine and enalapril groups. However, the
risk ratio for fatal or nonfatal MI was 9.5 for patients randomized to
nisoldipine rather than enalapril.

The American Heart Association (AHA) says in a related press release
that the findings provide additional proof "...that calcium
antagonists...may pose risks for certain people, including those with
diabetes and coronary heart disease." Moreover, the new data,
according to the AHA, show that these risks are not restricted to
patients taking short-acting calcium antagonists, since nisoldipine is
a long-acting formulation.

However, the authors of the NEJM paper point out that, because "...the
findings were based on a secondary end point of the study, the results
should be interpreted cautiously." For example, the apparent increased
risk of MI in patients taking nisoldipine may be the result of a
protective effect of enalapril, rather than a deleterious effect of
nisoldipine. Nonetheless, "...the difference between the two study
medications was still striking after adjustment for other variables
that may influence the incidence of cardiovascular end points," Dr.
Estacio and his team report.

The investigators conclude that, based on these data, "...an ACE
inhibitor is the preferred antihypertensive agent, rather than a
dihydropyridine calcium-channel blocker, for the prevention of
cardiovascular complications, specifically myocardial infarction, in
patients with NIDDM."

Elsewhere in the journal, Dr. Jeffrey A. Cutler of the National Heart,
Lung, and Blood Institute in Bethesda, Maryland, points out that,
until the results of other long-term, comparative trials of
antihypertensive medications in diabetic patients are available,
physicians should continue to consult the "Sixth Report of the Joint
National Committee on Prevention, Detection, Evaluation, and Treatment
of High Blood Pressure" when selecting antihypertensive regimens for
their patients.

N Engl J Med 1998;338:645-652,679-680.

-Westport Newsroom 203 319 2700