ACE-REMMERS VERGROTEN HET RISICO OP HYPOGLYKEMIE BIJ DIABETICI

Objective. To determine the association of hypoglycaemia in diabetic patients with the use of ACE inhibitors. Design. Nested case control study. Setting. Six medium sized Dutch cities (300.000 inhabitants). Method. Using data in the Dutch PHARMO system (1986-1992) 94 diabetic patients treated with insulin or with oral antidiabetic drugs, who had been admitted to hospital with hypoglycaemia, were identified. From the same cohort 654 control patients were selected at random. Results. With adjustment for a wide range of potential confounding factors, hypoglycaemia was significantly associated with current use of ACE inhibitors (odds ratio: 2.8 (95% CI 1.4-5.7)). Both among users of insulin and users of oral antidiabetic drugs, use of ACE inhibitors was significantly associated with an increased risk of hospital admission for hypoglycaemia (2.8 (1.2-6.4) and 4.1 (1.4-12.2), respectively). It was estimated that about 13.8% of all admissions for hypoglycaemia in diabetic patients were due to the use of ACE inhibitors. Conclusion. Although the use of ACE inhibitors for hypertension in diabetic patients has advantages over the use of other antihypertensive drugs, one should be aware of the increased risk of hypoglycaemia.