Key result
Ramipril significantly lowered the risk of diabetes mellitus in African Americans with hypertensive kidney disease compared with metoprolol (RR 0.53, P=0.001) or amlodipine (RR 0.49, P=0.003).
Why the study?
Does ramipril reduce the incidence of diabetes mellitus compared to metoprolol or amlodipine in African Americans with hypertensive kidney disease?
RCT (n=1,017)
Yes
Does ramipril reduce the incidence of diabetes mellitus compared to metoprolol or amlodipine in African Americans with hypertensive kidney disease?
Relative Risk: 0.53
Absolute Event Rate: 2.8% vs 4.5%
p-value: p=0.001
Ramipril is associated with a significantly lower risk of developing diabetes mellitus compared to amlodipine or metoprolol in African Americans with hypertensive kidney disease.
Supports ramipril preference over metoprolol or amlodipine to lower diabetes risk in African Americans with hypertensive kidney disease; extends ACEI benefits to this population.
BACKGROUND: The African American Study of Kidney Disease and Hypertension was a multicenter trial of African Americans with hypertensive kidney disease randomized to an angiotensin-converting enzyme inhibitor (ramipril), a beta-blocker (metoprolol succinate), or a calcium channel blocker (amlodipine besylate). We compared the incidence of type 2 diabetes mellitus (DM) and the composite outcome of impaired fasting glucose or DM (IFG/DM) for the African American Study of Kidney Disease and Hypertension interventions. METHODS: Cox regression models were used to evaluate (post hoc) the association of the randomized interventions and the relative risk (RR) of DM and IFG/DM and to assess the RR of DM and IFG/DM by several prerandomization characteristics. RESULTS: Among 1017 participants, 147 (14.5%) developed DM; 333 (42.9%) of 776 participants developed IFG/DM. Respective DM event rates were 2.8%, 4.4%, and 4.5% per patient-year in the ramipril-, amlodipine-, and metoprolol-treated groups. The RRs of DM with ramipril treatment were 0.53 (P = .001) compared with metoprolol treatment and 0.49 (P = .003) compared with amlodipine treatment. Respective IFG/DM event rates were 11.3%, 13.3%, and 15.8% per patient-year in the ramipril-, amlodipine-, and metoprolol-treated groups. The RRs of IFG/DM with ramipril treatment were 0.64 (P<.001) compared with metoprolol treatment and 0.76 (P = .09) compared with amlodipine treatment. The RRs of DM and IFG/DM with amlodipine treatment compared with metoprolol treatment were 1.07 (P = .76) and 0.84 (P = .26), respectively. CONCLUSION: Ramipril treatment was associated with a significantly lower risk of DM in African Americans with hypertensive kidney disease than amlodipine or metoprolol treatment.
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Denyse Thornley‐Brown (2006) conducted an RCT in Hypertensive kidney disease (n=1,017). Ramipril vs. Metoprolol succinate or amlodipine besylate was evaluated on Incidence of type 2 diabetes mellitus (DM) (RR 0.53, p=0.001). Ramipril significantly lowered the risk of diabetes mellitus in African Americans with hypertensive kidney disease compared with metoprolol (RR 0.53, P=0.001) or amlodipine (RR 0.49, P=0.003).
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