SHOULD ALL PEOPLE WITH DIABETES USE BLOOD PRESSURE PILL ACE INHIBITOR EVEN WITH NORMAL BLOOD PRESSURE ACE INHIBITORS HELP DIABETIC KIDNEY PROBLEM

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Should all people with diabetes take a blood pressure pill ACE inhibitor? Blood pressure pills with names like lisinopril, captopril,etc are used to treat other things beside blood pressure. ACE Inhibitors are known to reduce kidney problems in diabetics.There are two main types of diabetes. Type 2 diabetes is more common and tends to occur in older adults(but can happen in kids too). The problem in Type 2 diabetes is frequently "insulin resistance". Your pancreas may produce insulin but your body does not respond properly (resists) to the insulin. In Type 2 diabetes, the body has trouble using insulin, even if it is available.



Your brain needs a constant supply of blood glucose(sugar). Not enough glucose to the brain and you faint. Too much glucose circulating in the blood and you feel sick. The job of regulating blood glucose depends on a Yin and Yang relationship of two hormones. Insulin drives sugar from the blood into the cells of the body. Glucagon helps to increase sugar in the blood.

Symptoms of diabetes can include:

increased thirst or hunger

fatigue and weight loss

increased urination, especially at night

blurred vision

sores that do not heal





Among the complications of diabetes is kidney trouble a.k.a diabetic nephropathy. Many diabetic people have high blood pressure. So doctors often prescribe a blood pressure pill. Ace inhibitors are a class of blood pressure pills with names like lisonopril, captopril, enalapril, benzapril,etc. Ace inhibitors treat many things besides blood pressure,migraines,for example. ACE inhibitors block the enzyme ACE in the body from producing angiotensin II, a chemical that does things like narrow blood vessels and cause sodium retention.




"We know that ACE inhibitors slow the progression of diabetic kidney trouble (diabetic nephropathy). So they’re indicated for that, they’re indicated for hypertension why not just put all diabetics on them?" In other words doctors wonder should all people with diabetes be on an ace inhibitor blood pressure pill to protect their kidney even if they don't have a diagnosis of high blood pressure.

Read this article suggesting that perhaps most people with diabetes would benefit from certain cholesterol lowering medication



In this article in the medical journal The Lancet, researchers report about putting patients even without a diagnosis of high blood pressure on a fixed dose combination of ACE inhibitor and diuretic.The results were that diabetics who were on ace inhibitors and a diuretic (water pill) did better. "We assessed the effects of the routine administration of an angiotensin converting enzyme (ACE) inhibitor-diuretic combination on serious vascular events in patients with diabetes, irrespective of initial blood pressure levels or the use of other blood pressure lowering drugs".




The findings:



"The relative risk of death from cardiovascular disease was reduced by 18%… and death from any cause was reduced by 14%. Although the confidence limits were wide, the results suggest that over 5 years, one death due to any cause would be averted among every 79 patients assigned active therapy".

Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial

Simplifying Management of Type 2 Diabetes