ACE Inhibitors and the Diabetic Kidney

There are a lot of blood-pressure medicines to choose from. For the diabetic patient, not all choices are good ones.

Some blood-pressure medications have the side effect of raising blood sugar levels, and others mask the symptoms of low blood sugar, putting patients at risk of hypoglycemia. For these reasons and more, doctors prefer ACE inhibitors for their diabetic patients.

ACE Inhibitors

ACE (angiotensin-converting-enzyme) inhibitors are a class of drugs that are used to treat high blood pressure. They act to negate the effect of an enzyme in the body which produces angiotensin II.

Angiotensin II causes the muscles surrounding blood vessels to contract, narrowing the arteries, increasing blood pressure and forcing the heart to work harder. ACE inhibitors cause blood vessels to dilate and relax, counteracting the impact of the constricting muscle tension.

Kidney Disease

Diabetic patients are at increased risk for diabetic neuropathy because high blood sugar causes inflammation that damages the epithelial cells lining blood vessels, causing them to become hardened and inflexible and raising blood pressure. Elevated blood pressure can cause damage to the millions of tiny blood vessels (glomeruli) that serve as filters in the kidneys. The cumulative effect of this damage is impairment of the filtering mechanisms of the kidney, which is a significant issue for diabetics.

Benefits Beyond Blood Pressure

Doctors have another reason for prescribing ACE inhibitors to treat diabetics. This particular category of drug has been found to confer additional benefits to the kidney. Over time, it has been learned that ACE inhibitors actually slow the progression of diabetic kidney disease and chronic kidney disease, separate from their effect on high blood pressure. It is thought that this might be because the ACE inhibitors reduce proteins and excess amounts of fluid circulating in the bloodstream, reducing the volume of substances the kidneys need to filter out. This allows the kidneys to work more efficiently with less cumulative damage to the kidney.

There are such significant benefits to using these drugs that some doctors have actually made the decision to prescribe them to diabetic or chronic kidney disease patients who don't have blood pressure issues.

Side Effects, Etc

ACE inhibitors are generally well-tolerated with few significant side effects. The most common is a persistent dry cough. Other side effects include headaches, fever and chills, trouble swallowing or upset stomach. Patients should notify their physicians if they experience any side effects that make them uncomfortable.

Physicians might see the need to prescribe a combination of medications to address diabetes. While ACE inhibitors are often prescribed alone, they can also be part of a multi-prong approach to dealing with high blood pressure.

ACE inhibitor brands include benazepril, lisinopril, captopril, enalapril, ramipril and perindopril, among others. All ACE inhibitors have a name that ends in -pril.

Sources: Patient.co.uk and UpToDate