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ORIGINAL ARTICLES
 
The role of renin blockers in the prevention of diabetes
 
  Abdullah H. Alkhenizan,  Mohammed A. Alswes
 
ABSTRACT
 

Objectives: To evaluate the role of renin blockers angiotensin converting enzymes inhibitors (ACEI) or angiotensin receptor blockers (ARB) in the prevention of diabetes.
 
Methods: We did a meta-analysis using the Cochrane group methodology of all available randomized controlled trials (RCTs) that evaluated the role of renin blockers in which outcomes of new-onset diabetes was reported. This meta-analysis was conducted between April 2005-April 2006 at King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
 
Results: Thirteen trials including 91,388 individuals met the inclusion criteria. There was a statistically significant reduction in the incidence of new-onset diabetes in patients receiving renin blockers compared to other antihypertensive agents [relative risks=0.79; 95% confidence interval=0.75-0.84). There was a statistically significant reduction in the incidence of new-onset diabetes in patients receiving renin-blockers compared to diuretics, conventional antihypertensive therapy (diuretics or beta-blockers), and calcium channel blockers.
 
Conclusions: Renin blockers reduce the incidence of new-onset diabetes and should be considered as first line therapy, when indicated, in patients at high risk for diabetes.

 
 
Saudi Medical Journal 2007; Vol. 28 (1): 91-95
 
 

 

The prevalence of diabetes is increasing all over the world. From 2003 to 2025, the worldwide prevalence of diabetes in adults is expected to increase from 190 million to 328 million.1

Diabetes is associated with 5.2% of global mortality and accounts for at least 10% of the total health care expenditure in many countries.1,2 Hypertension (HTN) is associated with increased incidence of diabetes. Diabetes is also associated with left ventricular hypertrophy and congestive heart failure (CHF).3 Renin blockers are well established therapeutic interventions in the management of HTN and CHF.4,5 Renin blockers are shown to increase insulin sensitivity and therefore, are suggested as an effective intervention in preventing diabetes.6 Interventions that can be utilized in the treatment of HTN, CHF and prevents diabetes are expected to have a significant impact on patients with these conditions.

The primary objective of this meta-analysis is to evaluate the role of renin blockers [angiotensin converting enzymes inhibitors (ACEI) or angiotensin receptor blockers (ARB)] in the prevention of diabetes.

Methods. We included randomized controlled trials (RCTs) of angiotensin converting enzyme inhibitors or ARBs in which the incidence of new onset diabetes was reported. Studies of adults of either gender (18 years or older) were accepted. We included studies that compared ACE inhibitors or ARBs t

 
From the Department of Family Medicine and Polyclinic, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.

Received 7th May 2006. Accepted 9th September 2006.

Address correspondence and reprint request to: Dr. Abdullah H. Alkhenizan, Department of Family Medicine and Polyclinic, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia. Tel. +966 1 4647272 Ext. 31860. Fax. +966 1 4280508. E-mail: alkhenizan@hotmail.com

 
References

1. Sicree R, Shaw JE, Zimmet PZ. The global burden of diabetes. In: Gan D, Editor. Diabetes Atlas. 2nd ed. Brussels: International Diabetes Federation; 2003. p. 15–71.

2. Roglic G, Unwin N, Bennett P, Mathers C, Tuomilehto J, Nag S, et al. The Burden of Mortality Attributable to Diabetes Realistic estimates for the year 2000. Diabetes Car 2005: 28: 2130-2135.

3. Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol 1974; 34: 29–34.

4. Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The seventh report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII). JAMA 2003; 289: 2560-2572.

5. Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2005; 46; 1-82.
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