Impact of Angiotensin Converting Enzyme Inhibitor versus Angiotensin Receptor Blocker on Development of Glucose Intolerance and New-onset Diabetes Mellitus in Asian Population Ji Young Park 1, Seung-Woon Rha 2, Byoung Geol Choi 2, Jae Woong Choi 1, Sung Kee Ryu 1, Cheol Ung Choi 2, Dong Joo Oh 2 1: Cardiology Department, Eulji University, Eulji General Hospital, Seoul, Korea 2: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea European Society of Cardiology meeting, Amsterdam 2013 European Heart Journal (2013) 34 (Abstract Supplement), 336 and 817.

Background RAAS and Angiotensin II are activated in the insulin-resistant state, and RAAS inhibition has effects on insulin action and secretion A meta-analysis 1 of randomized controlled trials in patients with hypertension or chronic heart failure showed 22% risk reduction of new- onset diabetes mellitus (NODM) with ACE inhibitor/ARB therapy after mean follow-up of 4.5 years. By both reducing angiotensin II production and preserving bradykinin, ACE inhibitors have the advantage of further promoting vasodilation allowing maximal perfusion of insulin into tissues and favoring its release from the pancreas. However, there were limited data to compare the protective effect of ACE inhibitors versus ARBs on the development of NODM. 1. Sheen AJ Diab Metab 2004

Objectives of the study To evaluate the impact of hypertension on the development of new-onset diabetes (NODM) in the Asian population To compare the protective effect of ACE inhibitors versus ARBs on development of NODM in the Asian population.

Methods 4071 patients with no diabetes at baseline were included for the first objective of the study to assess the link between hypertension and NODM for a follow-up of 5 years patients using either ACE inhibitors or ARBs were monitored for the secondary objective. Propensity score matching yielded two groups of respectively 321 patients with equivalent baseline characteristics Primary end point: cumulative incidence of new-onset diabetes mellitus (NODM). NODM is defined as having a fasting blood glucose ≥126 or HbA1c ≥6.5%. Mean follow-up duration was 970 ± 288 days after adjustment for both treatment groups.

Cumulative Incidence of NODM depending on hypertension status HypertensivesNon hypertensives P value Incidence of NODM11.4%7.9%P=0.006

Cumulative incidence of NODM with antihypertensive treatment ACE inhibitors ARBs ACE inhibitors Incidence of NODM4.6%2.4%

Conclusion Hypertension was associated with an increased risk of developing NODM. In this study, the incidence of NODM was higher in the ARB group as compared with the ACE inhibitor group. Therefore, ACE inhibitors could be more effective than ARBs in preventing NODM