A:
Doctors recommend taking a medicine that can slow or prevent kidney disease if you have diabetes along with high blood pressure or signs of early kidney disease. There are two categories of drugs that can help: ACE inhibitors and angiotensin-receptor blockers (ARBs).
We have known for more than a decade that ACE inhibitors slow down kidney damage caused by diabetes. In 2001, ARBs were also shown to help prevent kidney disease. These drug groups are closely related. You should take one drug, not one drug from each group.
To find early kidney disease, you’d take a urine test called a “microalbumin” test. This test looks for trace amounts of albumin, a protein that should not leak into the urine if the kidneys are in perfect health.
Both ACEs and ARBs work the same way and offer a benefit that we think is equal. They lower the amount of a hormone that your body makes, called angiotensin II. Angiotensin II causes narrowed blood vessels and fluid retention. With an ACE or an ARB, there is more gradual flow of your circulation through filtering areas in your kidneys called “glomeruli.”
We don’t know for sure which of these changes helps the kidneys most. But we do see results. One study showed that diabetics were nearly one-third less likely to begin dialysis if they took an ARB for more than three years.
Medicines from both groups also treat high blood pressure. And they have been shown to help prevent heart attacks.
The main side effect of ACE inhibitors is a dry cough. ARBs don’t do this. Both drugs can cause a high blood potassium level, especially in people with more advanced kidney disease.
Lisinopril, an ACE inhibitor, is usually prescribed as a generic. The trade names for it are Zestril or Prinivi. The chart below lists other available ACE inhibitors and ARBs. Some of these medicines are also available in combination pills, packaged with other drugs that are commonly used in diabetes.
Examples of ACE inhibitors
- benazepril (Lotensin)
- captopril (Capoten
- enalapril (Vasotec)
- fosinopril (Monopril)
- lisinopril (Zestril/Prinivil)
- moexipril (Univasc)
- perindopril (Aceon)
- quinapril (Accupril)
- ramipril (Altace)
Examples of ARBs
- candesartan (Atacand)
- eprosartan (Teveten)
- irbesartan (Avapro)
- losartan (Cozaar)
- telmisartan (Micardis)
- valsartan (Diovan)
