Current guidelines recommend angiotensin-converting-enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) as a first-line therapy in diabetic hypertensive patients and for secondary prevention in patients with obstructive coronary artery disease (OCAD). However, the effects of using ACEI/ARB before the initial diagnosis of OCAD on major adverse cardiac and cerebral event (MACCE) in diabetic hypertensive patients remain unclear. This study investigated whether using ACEI/ARB before the initial diagnosis of OCAD could be associated with improved clinical outcomes in diabetic hypertensive patients. A total of 2501 patients with hypertension and diabetes, who were first diagnosed with OCAD by coronary angiography, were included in the analysis. Of the 2501 patients, 1300 did not used ACEI/ARB before the initial diagnosis of OCAD [the ACEI/ARB(-) group]; 1201 did [the ACEI/ARB(+) group]. Propensity score matching at 1:1 was performed to select 1050 patients from each group. Incidence of acute myocardial infarction (AMI), infarct size in patients with AMI, heart function, and subsequent MACCE during a median of 25.4-month follow-up were determined and compared between the 2 groups. Compared with the ACEI/ARB(-) group, the ACEI/ARB(+) group had significantly lower incidence of AMI (22.5% vs. 28.4%, p < 0.05), smaller infarct size in patients with AMI (pTNI: 5.7 vs. 6.8 ng/ml, p < 0.05; pCKMB: 21.7 vs. 28.7 ng/ml, p < 0.05), better heart function (LVEF: 60.0 vs. 58.5%, p < 0.05), and lower incidences of non-fatal stroke (2.4% vs. 4.6%, p < 0.05) and composite MACCE (23.1% vs. 29.7%, p < 0.05). No prior ACEI/ARB therapy was significantly and independently associated with non-fatal stroke and composite MACCE. In diabetic hypertensive patients, treatment with ACEI/ARB before the initial diagnosis with OCAD was associated with decreased incidence of AMI, smaller infarct size, improved heart function, and lower incidences of non-fatal stroke and composite MACCE. Trial registration Retrospectively registered

中文翻译：

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在梗阻性冠状动脉疾病的初步诊断之前，在糖尿病性高血压患者中实际使用ACEI / ARB：患者特征和长期随访结果。

当前的指南建议将血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB）作为糖尿病性高血压患者的一线治疗和阻塞性冠状动脉疾病（OCAD）患者的二级预防。但是，在OCAD初始诊断之前使用ACEI / ARB对糖尿病性高血压患者的主要不良心脏和脑事件（MACCE）的影响仍不清楚。这项研究调查了在最初诊断OCAD之前使用ACEI / ARB是否可以改善糖尿病性高血压患者的临床结局。分析中包括总共2501例高血压和糖尿病患者，这些患者首先通过冠状动脉造影术被诊断为OCAD。在2501名患者中，1300在最初诊断OCAD之前未使用ACEI / ARB [ACEI / ARB（-）组]；1201做过[ACEI / ARB（+）组]。倾向得分匹配为1：1，以从每组中选择1050名患者。确定了急性心肌梗塞（AMI）的发生率，AMI患者的梗塞面积，心功能以及随后的MACCE（中位值为25.4个月），并在两组之间进行了比较。与ACEI / ARB（-）组相比，ACEI / ARB（+）组的AMI发生率显着较低（22.5％对28.4％，p <0.05），AMI患者的梗死面积较小（pTNI：5.7 vs 。6.8 ng / ml，p <0.05； pCKMB：21.7 vs. 28.7 ng / ml，p <0.05），心脏功能更好（LVEF：60.0 vs. 58.5％，p <0.05），非致命性中风的发生率较低（2.4％vs. 4.6％，p <0.05）和复合MACCE（23.1％vs. 29.7％，p <0.05）。先前的ACEI / ARB治疗均未与非致命性卒中和复合MACCE显着且独立相关。在糖尿病高血压患者中，在最初用OCAD诊断之前用ACEI / ARB治疗与AMI发生率降低，梗死面积更小，心脏功能改善以及非致死性卒中和复合MACCE发生率降低相关。试用注册追溯注册