Abstract 8721: Stroke and Dual Inhibition
The results of previous studies have shown controversial results regarding combination therapy with both drugs in primary and secondary prevention trials for hypertensive patients. This study compared the effectiveness of ACEI and ARB in reducing stroke risk for patients with hypertension and type 2 diabetes mellitus. From a representative sample of a universal National Health Insurance program of Taiwan, we identified from type 2 diabetic patients, 18 years of age and above, with newly diagnosed hypertension in 2000–2005. They were divided into 4 sub-cohorts by the medication status: 1086 patients with ACEI, 771 patients with ARB, and 1078 patients with both ACEI and ARB, and 1469 patients with neither medicine. The stroke incidence density was the lowest (17.2 per 1000 person-years) in ARB sub-cohort, followed by ARB/ACEI combined sub-cohort and ACEI sub-cohort and the neither sub-cohort (19.8, 35.3 and 50.6 per 1000 person-years, respectively). Compared with the cohort taking neither medication, the corresponding hazard ratios (HRs) were 0.34 (95% confidence interval (CI) 0.23 – 0.53), 0.37 (95% CI 0.26 – 0.53) and 0.75 (95% CI 0.57 – 0.998) after controlling for sex, age, geographical area of patient resident, and other co-morbidities. The protective effects of ARB in stroke prevention were also significant for patients with co-morbidity of ACS, AF, CHF, CKD or hyperlipidemia. Medication combining ACEI and ARB changed little in the protective effect for stroke. This study suggests that ARB is the first chose for patients with both hypertension and DM and approximately sixty percent of stroke can be prevented.
- © 2010 by American Heart Association, Inc.