Witte KK, et al. - This prospective cohort study was performed to investigate whether β-adrenoceptor blockers (β-blockers) and ACE inhibitors (ACEI) were correlated with differential effects on mortality in chronic heart failure (CHF) patients with and without diabetes. In CHF patients with diabetes, increasing β-blocker dose was correlated with a greater prognostic advantage than without diabetes.

• Between 2006 and 2014, the physicians recruited 1,797 patients with CHF, with mean follow-up of 4 years.
• They expressed β-Blocker dose as the equivalent dose of bisoprolol (mg/day) and ACEI dose as the equivalent dose of ramipril (mg/day).
• They used Cox regression analysis to investigate the interaction between diabetes and drug dose on all-cause mortality.

• Compared to patients without diabetes, patients with diabetes were prescribed larger doses of β-blocker and ACEI.
• Although the effect was larger in people with diabetes (interaction P = 0.027), increasing β-blocker dose was associated with lower mortality in patients with diabetes (8.9% per mg/day; 95% CI 5-12.6) and without diabetes (3.5% per mg/day; 95% CI 0.7-6.3).
• With similar effect size in these groups (interaction P = 0.76), increasing ACEI dose was correlated with lower mortality in patients with diabetes (5.9% per mg/day; 95% CI 2.5-9.2) and without diabetes (5.1% per mg/day; 95% CI 2.6-7.6).