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Diabetes Medications and New Drugs

ACE inhibitors (Angiotensin Converting Enzyme Inhibitors)

What are ACE inhibitors?

These are a type of medication used to treat high blood pressure. They are also used in the treatment of heart failure and to help the heart recover after a heart attack.

People with diabetes are increasingly likely to receive treatment with an ACE inhibitor due to the increased occurrence of

  • High blood pressure
  • Diabetic kidney problems
  • Heart attacks
  • Heart failure

Some examples of ACE inhibitors:

Name

Trade name

‘usual dose’

Captopril

CapotenR

100-150 mg in divided doses

Enalapril

InnovaceR

10-20 mg once daily

Fosinopril

StarilR

10-40 mg once daily

Lisinopril

ZestrilR

10-20 mg once daily

Perindopril

CoversylR

4 mg once daily

Quinapril

AccuproR

20-40 mg daily

Trandalopril

GoptenR

1-2 mg daily

What are the side effects?

Side effects of ACE inhibitors can be considered in two groups: mild adverse effects which are a nuisance but not dangerous and the more serious effects

Mild adverse effects:

  • persistent dry cough; a common problem
  • nausea
  • headache
  • dizziness
  • altered taste sensation

Serious effects:

  • deterioration in kidney function
  • swelling of the face and hands (angio-oedema)
  • profound fall in blood pressure
  • rise in blood potassium levels

I have a dry cough – should I continue taking the tablets?

Cough is a well recognised side effect of ACE inhibitors. People with a persistent dry cough should change over to an Angiotensin Receptor Blocker (ARB) which does not have this side effect.

What precautions should be taken to avoid side effects?

Fall in blood pressure – is more common with the first dose and in those taking diuretics (water tablets). If you are on large doses of water tablets your doctor may reduce the dose before commencing the ACE inhibitor.  The first dose is usually taken at bed-time which helps minimise symptoms of low blood pressure.

Renal impairment – These drugs are not used in people with known renovascular disease (narrowing of the renal arteries). You should have your kidney function rechecked 2-4 weeks after starting on an ACE inhibitor and monitored regularly thereafter.

The following groups of people are more likely to develop kidney problems or high potassium levels.

  1. those on NSAIDs (anti-inflammatory drugs used for arthritis)
  2. people on potassium sparing diuretics such as spironolactone
  3. the elderly
  4. known vascular disease e.g. peripheral vascular disease

Who should not take an ACE inhibitor?

  • pregnancy
  • known renovascular disease
  • sensitivity to ACE inhibitors

ACE inhibitors in diabetic nephropathy

ACE inhibitors have been shown to have important benefits in diabetic nephropathy which include

  • less leakage of proteins from the kidneys
  • delay progression of protein leakage
  • delay the need for dialysis or transplantation

Provided there are no contra-indications all diabetic patients with nephropathy or established micro-albuminuria should be treated with an ACE inhibitor.

 

Dr Nishan Wijenaike
Consultant Diabetologist
West Suffolk Diabetes Service
Bury St Edmunds
September 2004

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