ACE inhibitors versus ARBs in Patients with Type 2 Diabetes Mellitus and Hypertension: A Comparative Study of Safety, Blood Pressure Control, and Renal Outcomes.
Both Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs) are recommended first-line agents for hypertension in patients with Type 2 Diabetes Mellitus (T2DM). However, treatment adherence is frequently compromised by class-specific adverse drug reactions (ADRs). This study compares the safety profiles, tolerability, blood pressure control, and short-term renal outcomes of ACEIs versus ARBs in a clinical setting. Methods: A prospective, observational study was conducted over 12 months in a tertiary care teaching hospital. One hundred adult patients ($N=100$) with T2DM and essential hypertension initiating monotherapy with either an ACEI ($n=50$, e.g., enalapril) or an ARB ($n=50$, e.g., losartan) were enrolled. Baseline demographic, clinical, and laboratory safety markers (serum potassium, serum creatinine, and eGFR) were recorded. Safety endpoints included the incidence of dry cough, hyperkalemia, acute kidney injury (eGFR decline greater than 30%), and therapy discontinuation rates. Efficacy was assessed via blood pressure (BP) and urinary albumin excretion rates. Results: Both groups achieved comparable, statistically significant reductions in systolic and diastolic BP, as well as urinary albumin excretion at 12 months ($p > 0.05$ for inter-group comparisons). However, the ARB group demonstrated a significantly superior safety and tolerability profile. Dry cough was reported in 16% of the ACEI group compared to 0% in the ARB group ($p < 0.01$), leading to a therapy discontinuation rate of 10% in the ACEI cohort. Mild hyperkalemia (serum $K^+ > 5.0 \text{ mEq/L}$) occurred in both groups (ACEI: 8% vs. ARB: 6%; $p > 0.05$) without any severe hyperkalemic events or acute kidney injury. Conclusion: While ACEIs and ARBs provide equivalent blood pressure control and renal protection, ARBs offer a significantly superior safety profile with a lower incidence of dry cough and lower treatment discontinuation rates. ARBs may be preferred as a first-line option to optimize long-term treatment adherence in patients with T2DM and hypertension.