Key result
ACE inhibitors and ARBs showed no significant difference in improving HOMA-IR overall (WMD -0.09), though ACE inhibitors were more effective in long-term interventions and in hypertensive patients with diabetes.
Why the study?
To summarize available evidence comparing the effects of ACE inhibitors versus ARBs on improving insulin sensitivity in hypertensive patients.
Do ACE inhibitors improve insulin sensitivity compared to ARBs in hypertensive patients?
Meta-Analysis (n=1,015)
Do ACE inhibitors improve insulin sensitivity compared to ARBs in hypertensive patients?
ACE inhibitors may offer superior improvements in certain insulin sensitivity markers (GIR and ISI composite) compared to ARBs in hypertensive patients, particularly with long-term use or in those with diabetes.
No overall HOMA-IR difference supports interchangeable ACE inhibitor/ARB use in hypertension; extends evidence to long-term and diabetic subgroups favoring ACE inhibitors.
INTRODUCTION: This meta-analysis aimed to summarize the available evidence to compare angiotensin-converting enzyme (ACE) inhibitors with angiotensin II receptor blockers (ARBs) on improving insulin sensitivity in hypertensive patients. METHODS: Randomized controlled trials (RCTs) comparing ACE inhibitors versus ARBs published with outcomes on homeostasis model assessment of IR (HOMA-IR), glucose infusion rate (GIR), the quantitative insulin sensitivity check index (QUICKI), insulin sensitivity index (ISI) composite, fasting plasma glucose (FPG), fasting plasma insulin (FPI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were searched through 5 databases. Data were searched from their inception to July 5, 2020. Stata 14.0 was used to perform the meta-analysis. RESULTS: Eleven RCTs (n = 1015) were included in this meta-analysis. Pooled analysis of studies showed no significant difference in HOMA-IR between ARBs and ACE inhibitors (WMD = -0.09, 95% CI: -0.69 to 0.50, P = 0.755); however, subgroup analysis of therapeutic duration showed a significant difference in HOMA-IR between ARBs and ACE inhibitors among the long-term intervention subgroup (>12 weeks) (WMD = 0.41, 95% CI: 0.06 to 0.76, P = 0.022) and hypertensive patients with diabetes mellitus subgroup (WMD = 0.55, 95% CI: 0.49 to 0.61, P < 0.001); results showed no significant difference between ARBs and ACE inhibitors on QUICKI score (WMD = -0.00, 95% CI: -0.03 to 0.03, P = 0.953) in hypertensive patients; however, the efficacy of ACE inhibitors on improving GIR and ISI composite was significantly better than that of ARBs (WMD = -1.09, 95% CI: -1.34 to -0.85, P < 0.001; WMD = -0.80, 95% CI: -1.24 to -0.36, P < 0.001, respectively). Furthermore, no significant differences were noted on FPG (WMD = 0.72, 95% CI: -1.39 to 2.83, P = 0.505), FPI (WMD = -0.48, 95% CI: -1.60 to 0.64, P = 0.398), SBP (WMD = -0.65, 95% CI: -1.76 to 0.46, P = 0.254), and DBP (WMD = -0.30, 95% CI: -1.70 to 1.10, P = 0.675) between ARBs and ACE inhibitors. CONCLUSION: Results from this meta-analysis showed that ACE inhibitors resulted in more effective improvement of HOMA-IR compared with ARBs among the long-term intervention and hypertensive patients with DM subgroup; furthermore, the efficacy of ACE inhibitors on improving GIR and ISI composite was significantly better than that of ARBs in hypertensive patients. However, ARBs had no significant difference in QUICKI score, FPG, FPI, SBP, and DBP compared with ACE inhibitors. Larger and better-designed studies are needed to further verify this conclusion.
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Yao et al. (2021) conducted a meta-analysis in Hypertension (n=1,015). Angiotensin-converting enzyme (ACE) inhibitors vs. Angiotensin II receptor blockers (ARBs) was evaluated on Homeostasis model assessment of insulin resistance (HOMA-IR) (WMD -0.09, 95% CI -0.69 to 0.50, p=0.755). ACE inhibitors and ARBs showed no significant difference in improving HOMA-IR overall (WMD -0.09), though ACE inhibitors were more effective in long-term interventions and in hypertensive patients with diabetes.
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