Do ACE Inhibitors Affect Diabetic Morbidity and Mortality?
IN RESPONSE: I appreciate Dr. Brungardt’s concern; however, nowhere did I refer to a reduction in overall mortality rate by these agents, given the absence of relevant data. My intent was to emphasize that ACE inhibitors have effects on the kidney that are independent of blood pressure reduction. The concept espoused was that these agents reduce renal mortality, not overall mortality. A recent analysis of many large, randomized studies that have evaluated the effects of the ACE inhibitors on cardiac events (including cardiac death rates) showed a significantly better outcome with ACE inhibitors compared with placebo [1]. These studies, however, were done in patients with established coronary and myocardial disease and were not population-based (unlike The Framingham Study and others). Large-scale intervention trials are urgently needed to evaluate the efficacy of ACE inhibitors and other antihypertensive agents in reducing overall mortality in patients with renal disease. Given the dec
