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Do ACE Inhibitors Affect Diabetic Morbidity and Mortality?
- George L. Bakris, MD
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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 decline in research dollars by governmental and private funding agencies, however, such studies are not likely to be done soon. Therefore, although Dr. Brungardt's point is well taken, I hope that a reduction in the rate of progression of renal disease will ultimately lead to decreased use of dialysis and hence a cost savings to Medicare.
George L. Bakris
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
