Original investigation
Ramipril-based versus diuretic-based antihypertensive primary treatment in patients with pre-diabetes (ADaPT) study
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* Corresponding author: Walter Zidek walter.zidek@charite.de
1 Medizinische Klinik IV, Charité - Universitätsmedizin Berlin, Campus Benjamin-Franklin, Berlin, Germany
2 St. Josephs Hospital, Krankenhausstr. 13, 49661 Cloppenburg, Germany
3 Diabetes Zentrum, Danziger Str. 2, 49610 Quakenbrück, Germany
4 Abteilung für Innere Medizin, St. Josefskrankenhaus, Landhausstr. 25, 69115 Heidelberg, Germany
5 Klinik für Innere Medizin, Nephrologie, Baldingerstr., 35033 Marburg, Germany
6 Institut für Pharmakologie und präventive Medizin, Menzelstrasse 21, 15831 Mahlow, Germany
7 Tempestas - Institut für Medizinische Forschung, Krankenhausstr. 13, 49661 Cloppenburg, Germany
8 Medizinische Abteilung, Sanofi-Aventis Deutschland, Potsdamer Str.8, 10785 Berlin, Germany
Cardiovascular Diabetology 2012, 11:1 doi:10.1186/1475-2840-11-1
Published: 9 January 2012Abstract
Background
Previous randomized controlled trials demonstrated a protective effect of renin angiotensin system blocking agents for the development of type-2 diabetes in patients with pre-diabetes. However, there are no real-world data available to illustrate the relevance for clinical practice.
Methods
Open, prospective, parallel group study comparing patients with an ACE inhibitor versus a diuretic based treatment. The principal aim was to document the first manifestation of type-2 diabetes in either group.
Results
A total of 2,011 patients were enrolled (mean age 69.1 ± 10.3 years; 51.6% female). 1,507 patients were available for the per-protocol analysis (1,029 ramipril, 478 diuretic group). New-onset diabetes was less frequent in the ramipril than in the diuretic group over 4 years. Differences were statistically different at a median duration of 3 years (24.4% vs 29.5%; p < 0.05). Both treatments were equally effective in reducing BP (14.7 ± 18.0/8.5 ± 8.2 mmHg and 12.7 ± 18.1/7.0 ± 8.3 mmHg) at the 4 year follow-up (p < 0.001 vs. baseline; p = n.s. between groups). In 38.6% and 39.7% of patients BP was below 130/80 mmHg (median time-to-target 3 months). There was a significant reduction of cardiovascular morbidity and mortality in favour of ramipril (p = 0.033). No significant differences were found for a change in HbA1c as well as for fasting blood glucose levels during follow-up. The rate of adverse events was higher in diuretic treated patients (SAE 15.4 vs. 12.4%; p < 0.05; AE 26.6 vs. 25.6%; p = n.s).
Conclusions
Ramipril treatment is preferable over diuretic based treatment regimens for the treatment of hypertension in pre-diabetic patients, because new-onset diabetes is delayed.