Primary Care Research

Only half of older people with diabetes receive ACE inhibitors or angiotensin receptor blockers to prevent cardiac problems

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) reduce the likelihood that older people with diabetes will suffer from cardiovascular events such as stroke and heart attack, as well as kidney failure, yet only about half of these patients receive them. In addition, some key cardiovascular risk factors which would warrant the use of ACE inhibitors and ARBs are being missed, according to a national survey supported by the Agency for Healthcare Research and Quality (T32 HS00020).

Allison B. Rosen, M.D., M.P.H., Sc.D., of the University of Michigan Health Systems, studied 742 people with diabetes who were 55 years and older and completed the nationally representative National Health and Nutrition Examination Survey each year from 1999 to 2002. She examined the prevalence of guideline indications for use of ACE inhibitors and ARBs. These included albuminuria (excess protein in the urine, indicative of kidney disease); cardiovascular disease (ranging from heart failure to angina, heart attack, stroke, and coronary artery disease); hypertension; and other cardiac risk factors (high cholesterol and smoking).

Overall, 92 percent of those surveyed had guideline indications for these medications. When additional cardiac risk factors were considered, the entire group of people with diabetes had indications for ACE inhibitors or ARBs; yet only 43 percent received them. Hypertension was associated with higher rates of use, while albuminuria and preexisting cardiovascular disease were not. Dr. Rosen suggests expanding indications for ACE inhibitors or ARBs to include all older individuals with diabetes regardless of their risk factors.

More details are in "Indications for and utilization of ACE inhibitors in older individuals with diabetes," by Dr. Rosen, in the April 2006 Journal of General Internal Medicine 21, pp. 315-319.

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