Bibliographic record
Abstract
ACE inhibitors are the agents of choice in the management of diabetic hypertension, yet their antihypertensive efficacy as single agents in diabetes is questionable. The purpose of this study was to ascertain the use and efficacy of ACE inhibitors in diabetic hypertension. This study was carried out in two-parts. The first part consisted of 58 hypertensive, diabetic subjects on ACE inhibitor monotherapy being followed longitudinally with respect to blood pressure control. In the second part of the study, 163 randomly selected hypertensive diabetics in a primary care setting were studied according to blood pressure control and microalbuminuria. Average follow-up for the longitudinal study was 22 months during which time HbA1c fell by 1.1% (p<.0001) confirming active intervention. Blood pressure, however, only decreased 3/2 mmHg from a baseline of 149/85 (p=.26) even though ACE inhibitor dose was increased in 75% of patients during the follow-up period. In a separate group of patients treated with an ACE inhibitor and a second antihypertensive agent, blood pressure fell by 14/10 mmHg (p=.0007). In the latter case, blood pressure decline was independent of the second agent used. Cross-sectionally, only 45% of hypertensive diabetics were on ACE inhibitor therapy. 27% of patients were on a non-ACE antihypertensive agent and 28% were on no antihypertensive therapy. From the perspective of microalbuminuria, only 51% of patients were on ACE inhibitors with only 5% of normotensive, microalbuminuric patients being on ACE inhibition. Using a cutoff of 130/85, only 30% of hypertensive diabetics met recommended blood pressure goals. Excluding ACE inhibitors, no other single agent proved superior in blood pressure control nor were there differences in efficacy between ACE inhibitor brands. We conclude that ACE inhibitors are underutilized in the management of diabetic hypertension or microalbuminuria. However, when used as single agents, their antihypertensive efficacy is limited suggesting two or more agents may be necessary for blood pressure control in diabetes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".