SHOULD ALL PATIENTS WITH TYPE 1 DIABETES MELLITUS AND MICROALBUMINURIA RECEIVE ANGIOTENSIN-CONVERTING ENZYME INHIBITORS?
“Angiotensin-converting enzyme inhibitors (ACE) are recommended for all patients with type 1 diabetes and micro-albuminuria, regardless of blood pressure.” Because microalbuminuria often occurs in the first 5 years after diagnosis, relatively young people may begin therapy with ACE inhibitors on the basis of this indication alone, and would be expected to continue to take these drugs indefinitely. This meta-analysis determined whether the response of albumin excretion rate to ACE has a threshold in patients with type 1 diabetes and microalbuminuria. It asked which subgroup, if any, is more likely to benefit from therapy. It explored the effects of covariates such as change in BP on treatment effect. Conclusion: All patients with type 1 diabetes should receive ACE. STUDY • Obtained data from 646 patients identified in 12 trials. All were normotensive. All had microalbuminuria. (20 ug/min to 200 ug/min.) • All studies were randomized to ACE or placebo. Follow-up at least 2 years. • A var
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