A widely used blood pressure drug may prevent diabetes in people at high risk for the disease, a study suggests.
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October 17, 2001
By Howard LeWine, M.D.
Harvard Medical School
How does this article relate to me?
ACE (angiotensin-converting enzyme) inhibitors originally were developed for treatment of high blood pressure. Captopril was the first, and now many are available, including enalapril, lisinopril, monopril, and ramipril. But ACE inhibitors now have several important uses in the treatment of heart and circulatory disease. ACE inhibitors are a mainstay in the treatment of congestive heart failure (CHF). Patients with CHF live longer and feel better when they take an ACE inhibitor.
People with kidney disease or who are at high risk for kidney disease, especially those with diabetes, take an ACE inhibitor to prolong good kidney function. After a heart attack, taking an ACE inhibitor helps the healing heart tissue and decreases the risk of another heart attack.
This article suggests that ACE inhibitors also may prevent type 2 diabetes. The results are preliminary, and much more evidence needs to be established to prescribe an ACE inhibitor only as a diabetes preventive.
What changes do I need to make?
When a drug class like the ACE inhibitors, has so many beneficial effects, I often find that with certain patients I have two or three reasons to prescribe it. For example, a patient who has a mild increase in fasting blood sugar (between 110 and 125) with a high-normal blood pressure and a family history of heart disease might be a very good candidate for a low-dose ACE inhibitor. Attempts to lower blood sugar and blood pressure with diet and exercise is a must, but I would suggest adding an ACE inhibitor also.
For patients with heart failure, an ACE inhibitor should always be tried. There are exceptions, such as advanced kidney disease, high blood potassium, and low blood pressure. Also, ACE inhibitors can cause a nagging throat tickle or cough, which may necessitate a change to an angiotensin receptor blocker.
Patients with high blood pressure who spill protein in their urine (proteinuria) are also great candidates for ACE inhibitors.
What can I expect in the future?
If this newest research regarding ACE inhibitors and prevention of diabetes is confirmed, then even more widespread use of ACE inhibitors can be expected. But our exuberance needs to be tempered by the known side effects: lip and throat swelling, high potassium (especially if you have decrease kidney function and take nonsteroidal anti-inflammatory drugs like ibuprofen, naproxen, Celebrex, and Vioxx), and worsening kidney function if your blood pressure gets too low.
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Diabetes
