ACE Inhibitors Blood Pressure Control in Diabetes
Overview
These disease processes tend to go hand in hand; high blood pressure is very common among people with diabetes. High blood pressure also contributes to the development of diabetic nephropathy (kidney disease).Furthermore, those with diabetes tend to have worse outcomes (longer hospitalizations, longer recovery times and higher risks of infection) from major heart problems. Therefore, health-care providers treat hypertension in concert with diabetes.
While ACE inhibitors don't directly lower blood sugar, they can contribute to blood sugar control by increasing the body's sensitivity to insulin. Insulin helps the body metabolize glucose (sugar) and move it from the bloodstream into cells, where it acts as a source of energy.
Many ACE inhibitors are available in the United States, including Capoten (captopril), Prinivil and Zestril (lisinopril), Vasotec (enalapril), Lotensin (benazepril), Altace (ramipril), Accupril (quinapril), Monopril (fosinopril), Mavik (trandolapril), Aceon (perindopril) and Univasc (moexipril).
History of Use
ACE inhibitors have been FDA-approved for treating hypertension since 1981. Over time, ACE inhibitor use has expanded dramatically to treat cardiovascular disease and related conditions.How They Work
ACE inhibitors lower blood pressure by preventing the body from producing the hormone angiotensin II. Angiotensin II causes vasoconstriction (narrowing of blood vessels) and fluid retention, resulting in hypertension. By reducing blood pressure and fluid retention, ACE inhibitors help to control heart failure. ACE inhibitors may also prevent and control diabetic nephropathy (kidney disease) and help control diabetic retinopathy (eye problems). ACE inhibitors do not slow the heartbeat or directly lower blood sugar.Who Should Avoid
People with very low blood pressure (hypotension), or who have had an allergy or cough related to ACE inhibitors, should not use ACE inhibitors. Neither should those with renal artery stenosis, pregnant women, and women trying to conceive.People with significant kidney damage require adjusted dosing of ACE inhibitors.
Side Effects and Risks
All blood pressure medications carry a risk of hypotension, with symptoms including lightheadedness, dizziness, nausea, sweating and possible loss of consciousness.Rarely, ACE inhibitors can cause low blood sugar (hypoglycemia). This occurs in people with diabetes who have blood sugar levels that are otherwise well-controlled by diet and other antidiabetic medications.
ACE inhibitors can cause coughing in some individuals. If this occurs, they should discuss this with their health-care providers, who may substitute different blood pressure medications.
Other 'Off-Label' Uses
ACE inhibitors may help prevent the onset of type 2 diabetes. In addition, ACE inhibitors may help control abnormal heart rhythms, particularly when used after a heart attack.ACE inhibitors are used off-label in the treatment of such diseases as rheumatoid arthritis, migraines, Raynaud's phenomenon and Bartter syndrome.