Key result
Continuous use of RAS blockers for up to 18 months in hypertensive prediabetic patients significantly reduced fasting blood sugar, postprandial blood sugar, and HbA1C levels.
Why the study?
Hypertensive patients have a high prevalence of prediabetes, and RAS blockers may slow the progression from impaired glucose tolerance to overt diabetes mellitus.
Do ACE inhibitors or ARBs improve glycemic indices in hypertensive patients with prediabetes?
Cohort (n=125)
No
Do ACE inhibitors or ARBs improve glycemic indices in hypertensive patients with prediabetes?
Mean Difference: 10.22
Absolute Event Rate: 101.35% vs 110.18%
p-value: p=<0.001
In hypertensive patients with prediabetes, continuous use of ACE inhibitors or ARBs for 18 months is associated with significant improvements in glycemic indices, particularly in younger patients.
May support glycemic benefit of RAS blockers in hypertensive prediabetes; hypothesis-generating, needs RCTs before practice change.
Hypertensive patients have a high prevalence of prediabetes and type II Diabetes mellitus. As per International Diabetic Federation, it has been estimated that more than 470 million people will have prediabetes by 2030. Approximately 5-10% of prediabetes progresses to overt diabetes mellitus, with the same proportion converting back to normoglycemia. In patients who are on Renin-Angiotensin System [RAS] blockers either an Angiotensin converting enzyme inhibitor (ACEI) or an Angiotensin receptor blocker (ARB) would slow down the progress of prediabetic state to overt or frank diabetes mellitus. This was a prospective, observational cohort study and a total of 125 hypertensive patients with impaired glucose tolerance were included in the study who were either on ACE inhibitor or ARB monotherapy. An oral Glucose Tolerance Test (GTT) was done at baseline for screening prediabetic patients, then a periodical assessment of glycemic indices, (fasting blood sugar, 2 hr postprandial blood sugar, and glycosylated hemoglobin), lipid profile, and complication status during the study period were evaluated every 3 months for18months. At the end of 1½ years, for patients belonging to the age group 18-54 years the FBS, PPBS, and HbA1C levels decreased significantly when the RAS blocking drugs (ACEIs and ARBs) were used continuously for 1 year and then they got stabilized. The beneficial effect was seen more in the younger age group 18-54 years old patients. Male above 54 years and females above 49 were resistant to the beneficial effects. In hypertensive patients with impaired glucose tolerance, the blockade of RAS with either ACE inhibitor or ARB has a significant preventive effect on the progression of Type II DM. It may be concluded from the finding of the present study that younger hypertensive patients (18-54 years) of either sex if found to be pre-diabetic may be administered ACEI or ARB as suitable for them. The treatment should be continued vigorously for one year and then it may be maintained to continue the beneficial effect.
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Bose et al. (2022) conducted a cohort in Prediabetes with hypertension (n=125). RAS blockers (ACE inhibitors or ARBs) was evaluated on Mean difference in Fasting Blood Sugar (FBS) from baseline to 18 months (MD 10.22 mg/dl, p=<0.001). Continuous use of RAS blockers for up to 18 months in hypertensive prediabetic patients significantly reduced fasting blood sugar, postprandial blood sugar, and HbA1C levels.
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