ACE inhibitors and angiotensin receptor blockers (ARBs) have similar effects on the risk of all-cause mortality, major adverse cardiac events, and hospitalization for hyperkalemia or acute kidney injury (AKI) in patients with preexisting diabetic retinopathy, according to a new study.

The study, by Chia-Jen Shih,, MD, of the National Yang-Ming University in Taipei, Taiwan, and colleagues, included 19,538 patients with diabetic retinopathy: 9,769 receiving ACE inhibitors matched by propensity scores to 9,769 patients receiving ARBs. The mean follow-up period was 60.2 and 72.2 months in the ARB and ACE inhibitor groups, respectively.

In intention-to-treat analyses, the rates of all-cause mortality in the ARB and ACE inhibitor groups were 26.0 and 27.7 per 1,000 person-years, respectively, and the rates of major adverse cardiac events were 18.2 and 19.0 per 1,000 person-years, respectively, according to findings published online in the Canadian Medical Association Journal. The differences between the cohorts were not statistically significant. The researchers defined major adverse cardiac events as myocardial infarction, ischemic stroke, and cardiovascular death.

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Results also showed no statistically significant differences between the ARB and ACE inhibitor groups regarding the rates of hospital admission for hyperkalemia (5.9 per 1,000 person-years in both groups) and AKI (12.6 and 12.4 per 1,000 person-years, respectively).

“Our findings support the existing evidence that ACE inhibitors and ARBs are equally effective and safe in this patient population, which may aid treatment decisions based on individuals’ adherence or tolerance,” the authors concluded.