Comment in:

ACP J Club. 2007 Jan-Feb;146(1):10.

Curr Atheroscler Rep. 2007 Aug;9(2):95.

Curr Atheroscler Rep. 2007 Oct;9(4):255.

Curr Diab Rep. 2007 Feb;7(1):53-5.

J Clin Hypertens (Greenwich). 2007 Jan;9(1):73-5.

N Engl J Med. 2006 Oct 12;355(15):1608-10.

N Engl J Med. 2007 Feb 1;356(5):522-3; author reply 523-4.

N Engl J Med. 2007 Feb 1;356(5):522; author reply 523-4.

N Engl J Med. 2007 Feb 1;356(5):523; author reply 523-4.

Prev Cardiol. 2007 Winter;10(1):48-51.

Effect of ramipril on the incidence of diabetes.

McMaster University, Hamilton, Canada.

BACKGROUND: Previous studies have suggested that blockade of the renin-angiotensin system may prevent diabetes in people with cardiovascular disease or hypertension. METHODS: In a double-blind, randomized clinical trial with a 2-by-2 factorial design, we randomly assigned 5269 participants without cardiovascular disease but with impaired fasting glucose levels (after an 8-hour fast) or impaired glucose tolerance to receive ramipril (up to 15 mg per day) or placebo (and rosiglitazone or placebo) and followed them for a median of 3 years. We studied the effects of ramipril on the development of diabetes or death, whichever came first (the primary outcome), and on secondary outcomes, including regression to normoglycemia. RESULTS: The incidence of the primary outcome did not differ significantly between the ramipril group (18.1%) and the placebo group (19.5%; hazard ratio for the ramipril group, 0.91; 95% confidence interval [CI], 0.81 to 1.03; P=0.15). Participants receiving ramipril were more likely to have regression to normoglycemia than those receiving placebo (hazard ratio, 1.16; 95% CI, 1.07 to 1.27; P=0.001). At the end of the study, the median fasting plasma glucose level was not significantly lower in the ramipril group (102.7 mg per deciliter [5.70 mmol per liter]) than in the placebo group (103.4 mg per deciliter [5.74 mmol per liter], P=0.07), though plasma glucose levels 2 hours after an oral glucose load were significantly lower in the ramipril group (135.1 mg per deciliter [7.50 mmol per liter] vs. 140.5 mg per deciliter [7.80 mmol per liter], P=0.01). CONCLUSIONS: Among persons with impaired fasting glucose levels or impaired glucose tolerance, the use of ramipril for 3 years does not significantly reduce the incidence of diabetes or death but does significantly increase regression to normoglycemia. (ClinicalTrials.gov number, NCT00095654 [ClinicalTrials.gov].). Copyright 2006 Massachusetts Medical Society.

PMID: 16980380 [PubMed - indexed for MEDLINE]