Key result
Ramipril reduced cardiovascular outcomes and mortality by 22% in high-risk patients and by 25% in patients with diabetes mellitus, while also demonstrating nephroprotective effects.
Why the study?
To review major clinical studies examining the efficacy and advantages of the ACE inhibitor ramipril in patients with arterial hypertension and diabetes mellitus.
Does ramipril improve cardiovascular and renal outcomes in patients with arterial hypertension and diabetes mellitus?
Does ramipril improve cardiovascular and renal outcomes in patients with arterial hypertension and diabetes mellitus?
Ramipril provides significant cardiovascular, nephroprotective, and metabolic benefits in patients with hypertension and diabetes, distinguishing it from other ACE inhibitors.
Supports ramipril consideration in high-risk and diabetic patients; leaves open prospective validation of benefits.
AH and diabetes mellitus are comorbid diseases and are interconnected by general pathophysiological mechanisms of development, similar to cardiovascular complications. The presence of a close relationship between AH and diabetes mellitus is due to the importance of activation of the renin-angiotensin-aldosterone system, which underlies the remodeling of the cardiovascular system and the development of complications. According to modern clinical guidelines, ACE inhibitors are the drugs of choice in the treatment of AH in combination with diabetes mellitus. The use of ACE inhibitors in patients with AH and diabetes mellitus is accompanied by a reduction in the relative risk of cardiovascular outcomes and mortality. A scientific review of major clinical studies with the results of efficacy of ACE inhibitor ramipril in patients with AH and diabetes mellitus is presented. Ramipril has a high affinity for ACE-1 and kinase II enzymes, pronounced clinical and organoprotective effects, proven to influence the prognosis. The HOPE study showed a 22% reduction in cardiovascular outcomes and mortality in high-risk patients treated with Ramipril (p < 0.001), and a 25% reduction in a subgroup of patients with diabetes mellitus. In a large retrospective cohort analysis, ramipril had a lower risk of mortality in patients with AH and diabetes mellitus compared to other ACE inhibitors (captopril, enalapril, fosinopril). In a number of studies (ATLANTIS, MICRO-HOPE, DIABHYCAR) in patients with diabetes mellitus and MAU, ramipril contributed to a significant slowdown of MAU progression and a significant regression of MAU, reducing the risk of diabetic nephropathy by 22%. This confirms the pronounced nephroprotective effect for primary and secondary nephropathy prevention. Several studies (AASK, HOPE, DREAM, ADaPT) using ramipril have shown a 17-36% reduction in the risk of the development of new cases of type 2 diabetes mellitus. Thus, the evidence on the efficacy of ramipril has allowed to expand indications for its use not only for cardiovascular diseases (AH, chronic heart failure, MI), but also for diabetes mellitus and diabetic nephropathy, which significantly differs the drug from other ACE inhibitors.
No takes yet. Share an insight, caveat, or question.
М. В. Леонова (2020) conducted a review in Arterial hypertension and diabetes mellitus. Ramipril vs. Placebo or other ACE inhibitors was evaluated. Ramipril reduced cardiovascular outcomes and mortality by 22% in high-risk patients and by 25% in patients with diabetes mellitus, while also demonstrating nephroprotective effects.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: