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Lisinopril For Kidney Protection In Diabetes

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Lisinopril: Cardiac Uses and Mechanism

You should know that insulin can help you manage your diabetes and prevent further damage to your kidneys. If youre suffering from diabetes, its important to consult a doctor to make sure that youre a good candidate for the condition. If youre looking for more information, you can read about the various types of diabetes available, as well as how to get a free online health assessment. In many cases, its possible to avoid a doctors visit by doing simple exercises. If youre not familiar with the signs and symptoms of diabetes, you can read online articles about the condition and learn about its treatment.

Maintain Your Blood Glucose Levels In The Optimum Range

Your doctor will advise you to monitor your sugar levels after meals, exercising, and also how often you should track your blood glucose level to test whether your insulin is working. She will also advise you to get a regular A1C test. This is a blood test that shows your average blood glucose level over the past three months. The A1C is also one of the best tests to see if your blood sugar levels are controlled. A high A1C number shows that your blood glucose levels have been high during the past three months, which can be a problem for your kidneys.

Ask your healthcare practitioner what your A1C test score should be and maintain your blood sugar levels within range to protect your kidney health. Most type 2 diabetes patients are advised to keep their A1C below seven percent. Ask your doctor how much your score should be. Remember, reaching your A1C goal numbers will help you protect your kidneys.

What The Researchers Found

Compared with placebo, ACE inhibitors

  • reduced the risk of diabetic kidney disease by 29%. Similar benefits occurred in people with and without high blood pressure and also when compared with calcium channel blockers.
  • reduced the risk of dying by 16%.
  • increased the risk of cough by 84%.

There were no differences in the risk of headache or elevated potassium in the blood .

Compared with placebo, angiotensin-receptor blockers

  • did not reduce the risk of diabetic kidney disease or dying from this condition.

There were no differences in the risk of cough, headache, or elevated blood potassium.

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Take All Your Prescribed Medicines Regularly

Medicines are an important part of your diabetes mellitus treatment plan. Your doctor will prescribe insulin and other medicines based on your specific needs. You may also be prescribed BP lowering medicines like ACE inhibitors and ARBs. These medicines also help slow kidney damage. Both play a special role in protecting your kidneys, especially if you are a diabetic with DKD and high blood pressure. In order to prevent further damage to your kidneys, one has to ensure that they are adhering to your treatment plan properly.

Role Of Calcium Channel Blockers

PEMAPRIL

A direct comparison between an ARB and a CCB was attempted by the MicroAlbuminuria Reduction With VALsartan study in patients with type 2 diabetes and microalbuminuria . A total of 332 patients with type 2 diabetes and microalbuminuria, with or without hypertension, were randomly assigned to 80 mg/d valsartan or 5 mg/d amlodipine for 24 wk. A target BP of 135/85 mmHg was aimed for by dose-doubling followed by addition of bendrofluazide and doxazosin whenever needed. The primary end point was the percentage change in albuminuria from baseline to 24 wk. The albuminuria at 24 wk was 56% of baseline with valsartan and 92% of baseline with amlodipine, a highly significant between-group effect . Valsartan lowered albuminuria similarly in both the hypertensive and the normotensive subgroups. More patients reverted to normoalbuminuria with valsartan . In summary, for the same level of attained BP and the same degree of BP reduction, valsartan lowered albuminuria more effectively than amlodipine in patients with type 2 diabetes and microalbuminuria.

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Ace Inhibitors Improve Diabetic Nephropathy Through Suppression Of Renal Mcp

Diabetes Care

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  • Berthold Amann, Ralph Tinzmann, Bernhard Angelkort ACE Inhibitors Improve Diabetic Nephropathy Through Suppression of Renal MCP-1. Diabetes Care 1 August 2003 26 : 24212425.

    OBJECTIVEChemokines play an important role in the pathogenesis of diabetic nephropathy. Angiotensin II induces several fibrogenic chemokines, namely monocyte chemoattractant protein-1 and transforming growth factor-. The progression of diabetic nephropathy can be retarded by ACE inhibitors in patients with type 1 and type 2 diabetes. We examined if blockade of the renin-angiotensin system lowered urinary levels of the chemokine MCP-1 and correlated urinary MCP-1 with parameters of renal function and glucose and lipid metabolism before and after 1 year of treatment with an ACE inhibitor.

    RESEARCH DESIGN AND METHODSIn 22 patients with type 2 diabetes and diabetic nephropathy in stages 35, treatment with the ACEI lisinopril was initiated. Before treatment and after 12 months of continuous therapy, proteinuria, creatinine clearance, uMCP-1 levels, BMI, HbA1c, and serum cholesterol were assessed.

    Ace Inhibitors And Esrd

    Despite examining the aforementioned effects on renal function and proteinuria, no studies conclusively demonstrate an effect of ACE inhibitors on the progression to ESRD in patients with type 2 diabetes. Although the majority of studies to date have included only the previously described markers of renal disease, the Heart Outcomes Prevention Evaluation 19 measured microalbuminuria, a marker of cardiovascular disease, and its association with cardiovascular and renal outcomes in a large number of patients with type 2 diabetes after longterm treatment with ramipril. This cardiovascular outcome study was not sufficiently powered to evaluate renal outcomes and hence, while ramipril significantly reduced the risk of a combined microvascular outcome, it had no significant effect on the progression to ESRD as a solo end point.18

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    Can I Ever Stop Taking These Medications

    You should talk to your healthcare provider before you stop taking these medications. Stopping them suddenly can cause serious and life-threatening medical events, especially ones like heart attack, stroke or worsening heart failure.

    Depending on why you take an ACE inhibitor, it may be possible to improve your blood pressure to the point where its no longer needed. Your doctor can help taper off your dose until its safe to stop taking it.

    In cases where you still have the original health condition but want to stop taking an ACE inhibitor, your healthcare provider can usually help you. They can offer medication alternatives and assist you in switching to another drug that can also help you.

    If you miss a dose

    If you miss a dose of your ACE inhibitor unless it is closer to the time for your next dose than the one you missed you should take the dose as soon as possible. If its been too long, wait and take only the next dose. Dont take more than your prescribed dose to catch up because this can cause severe, dangerous lowering of blood pressure.

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    Lisinopril For Type 2 Diabetes

    Lisinopril

    by Med-World | Aug 18, 2015 | Learning Center I was recently diagnosed with type 2 Diabetes and put on several new medications because of it. One of the medications is Lisinopril. Upon doing my research, this seems to be a blood pressure pill, but I dont have high blood pressure. Could this be a mistake? Lisinopril is indeed primarily used as a blood pressure medication, but using it to treat diabetes is not a mistake. When a person develops diabetes they are at an increased risk of kidney problems, sometimes leading to chronic kidney disease. Lisinopril works specifically in the kidney by reducing constriction of the blood vessels surrounding it which helps benefit overall kidney function. These particular actions of Lisinopril are protective in nature. The ability of Lisinopril to protect the kidney reduces the risk of chronic kidney disease and slows the progression if there is existing chronic kidney disease. In fact, the American Diabetes Association says the addition of a blood pressure medication, such as Lisinopril, is the current recommended therapy for all patients who have been diagnosed with diabetes. With all that being said, your doctor is spot on! This weeks edition co-authored with Emma Siegmann, PharmD Candidate May 2016, SWOSU College of Pharmacy.Continue reading > >

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    Role Of Combined Therapy With Ace Inhibitors And Ccb

    In many ways, ACE inhibitors and ndCCB complement each otherâs actions. The combination of an ACE inhibitor, which reduces the formation of angiotensin II, and a CCB, which weakens the effect of angiotensin II on the target organ, theoretically should be more effective than either drug alone.

    Studies by Berne et al. indicated that ACE inhibitors improve glucose use and insulin sensitivity in hypertensive patients with type 2 diabetes and favorably modify the disease course. As a result, in the treatment of hypertension in patients with type 2 diabetes, ACE inhibitors have been the drugs of choice for initial monotherapy in patients with albuminuria/proteinuria . If the BP response is inadequate, then the additional use of an ndCCB or a diuretic therefore might be a prudent course of action . In the TRAVEND study, the effect of antihypertensive combinations on metabolic control and albuminuria in patients with type 2 diabetes showed that the combination of verapamil plus trandolapril allowed better metabolic control than enalapril plus hydrochlorothiazide .

    Genes And Family History

    As in type 1 diabetes, certain genes may make you more likely to develop type 2 diabetes. The disease tends to run in families and occurs more often in these racial/ethnic groups:

    • African Americans
    • Native Hawaiians
    • Pacific Islanders

    Genes also can increase the risk of type 2 diabetes by increasing a persons tendency to become overweight or obese.

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    Protecting The Kidneys In People With Diabetes

    In people with diabetes, lisinopril helps prevent kidney disease from progressing and reduces the amount of protein that goes unfiltered by the kidneys and ends up in urine . An ACE inhibitor like lisinopril is recommended as first-line treatment for high blood pressure in people with diabetes and in people with microalbumin in their urine.

    Ace Inhibitor Effects On Markers Of Renal Disease: Renal Function

    Lisinopril 20 mg  Pharmatech Company for Drugs and Medical Supply

    Neutral Findings for ACE Inhibitors in Type 2 Diabetes. In a small trial of patients with type 2 diabetes whose hypertension was adequately controlled throughout the study period, treatment with either lisinopril or nondihydropyridine calcium channel blockers reduced the rate of decline in creatinine clearance relative to treatment with a adrenergic antagonist over an average followup period of 63 months .12 However, lisinopril and the nonDHPCCBs produced approximately parallel changes in the rate of decline in creatinine clearance. Similarly, in two separate studies, people with primarily stage 1 or early stage 2 nephropathy demonstrated a rate of decline in creatinine clearance that was similar to participants treated with either enalapril, in one study, and ramipril in the other versus a DHPCCB .6, 13 These results suggest that ACE inhibitors exhibited a beneficial effect on markers of renal insufficiency however, the benefit conferred by ACE inhibitors was not superior to that conferred by calcium channel blockers. Keep in mind that the studies with calcium antagonists were carried out in people with relatively well preserved renal function and did not have a long duration of followup as would be required in such a participant population. Also in the study by Bakris et al.,12 the ACE inhibitor was better than the blocker on renal disease progression. This superiority of ACE inhibitors has also been described in other studies with blocker comparisons.14

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    Characteristics Associated With Acei Or Arb Initiation

    In the bivariate assessment, attributes associated with lower likelihood of treatment initiation included male sex, White race, Northeast region, more advanced CKD , UACR category A1, and MRA use . Characteristics associated with higher likelihood of ACEi or ARB initiation included obesity, use of antidiabetic medications, and the use of most cardiovascular agents except for MRAs . Key predictors of ACEi or ARB treatment initiation in the final model are presented in Table 3. Characteristics associated with lower likelihood of treatment initiation included White race, Northeast region, presence of atrial fibrillation, depression, pain disorders, coronary artery disease, and MRA use. Those meeting criteria for resistant hypertension and users of SGLT2is were 45% and 63% less likely to initiate therapy, respectively. Users of -blockers, centrally acting antihypertensives, and statins were more likely to initiate ACEis or ARBs.

    What Is An Ace Inhibitor How Does It Work

    An ACE inhibitor, as its name indicates, works by inhibiting the angiotensin-converting enzyme, thus, preventing the conversion of angiotensin I to angiotensin II. Angiotensin II is an enzyme that is responsible for causing the smooth muscles of blood vessels to contract, thereby raising blood pressure. Hence, when an ACE inhibitor like lisinopril blocks the production of angiotensin II, relaxation of the blood vessels occurs, leading to a decrease in blood pressure. Regarding heart failure patients, ACE inhibitors make it easier for the heart to pump blood. Studies have shown that people treated with an ACE inhibitor after a heart attack survive longer than those who do not receive this class of drugs.

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    Dont Let Stress Get You Down

    Managing diabetes mellitus isnt always easy. Feeling stressed, sad, or helpless is fairly common when you are living with diabetes. Since long-term stress can raise your blood glucose and blood pressure both, you can learn ways to de-stress. Deep breathing, meditation, yoga, gardening, taking a walk, listening to your favorite music, are all helpful examples of activities that can reduce stress.

    When Good Kidneys Go Bad

    LISINOPRIL FOR HIGH BLOOD PRESSURE: Is it right for you? | What are the Side Effects?

    Your kidneys, which are each about the size of your fist, are located near the middle of your back, just below the rib cage. By no coincidence, they are shaped like kidney beans. One of their jobs is to filter waste products and extra water from the bloodstream. This waste and excess water, in the form of urine, flow through tubes called ureters and into the bladder. The bladder stores urine until it is full enough to create the urge to urinate.

    How does this filtering process work? Each kidney is made up of about one million tiny filtering units called nephrons. Tiny blood vessels called arterioles deliver blood to the nephrons. Within each nephron, the blood vessels form a complex called a glomerulus. It is within these glomeruli that the filtering activity actually takes place. The filtered blood leaves through another arteriole and is eventually carried back to the heart. Meanwhile, the material filtered from the blood passes through a tubule, where it is converted to urine, and then carried to the bladder through the ureters.

    Diabetes sets the stage for kidney damage. Chronic high blood glucose levels, often in combination with hypertension , damage the glomeruli and progressively diminish kidney function. This type of kidney dysfunction is known as diabetic nephropathy. In its earliest stages, it has no symptoms however, the silent damage going on behind the scenes can still pave the way for kidney failure.

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    Why Is Blocking Ace So Effective

    ACE is part of your bodys blood pressure control process. Enzymes like ACE are useful because they are catalysts. That means they make it easier for certain chemical reactions to happen.

    ACE raises your blood pressure in two ways:

    Angiotensin I conversion

    Angiotensin is a hormone found in your body in four different forms . ACE turns angiotensin I into angiotensin II, which has multiple effects throughout your body.

    Some of those effects all of which increase your blood pressure include:

    • Circulatory system: causes your blood vessels to tighten and narrow.
    • Kidneys: limits how much sodium and water are removed from your body.
    • Endocrine system: causes your adrenal gland to release aldosterone, a hormone that your kidneys use to control sodium, potassium and fluid levels in your body.

    Bradykinin breakdown

    Bradykinin is a protein that lowers your blood pressure by relaxing your blood vessels and helping your kidneys remove sodium from your body. ACE breaks bradykinin down. Less available bradykinin makes your blood pressure go up.

    Blocking ACE means theres less angiotensin II to raise your blood pressure, and theres more bradykinin to lower your blood pressure.

    Diabetics Get Kidney Protection From Arbs

    May 20, 2001 Five million Americans have both type 2 diabetes and high blood pressure, a one-two punch that can seriously damage the kidneys and the heart. Now results from three landmark studies of almost 4,000 diabetic patients suggest that a specific class of blood pressure drugs called angiotensin receptor blockers, or ARBs, can protect kidneys and reduce the need for kidney dialysis or transplant.

    Results from all three studies were released Saturday at the annual meeting of the American Society of Hypertension.

    Among the findings were the following:

    • A 28% reduction in the risk of kidney failure among diabetics with established kidney disease.
    • A slowing of the progression of kidney disease.
    • A 20% reduction in death.

    None of the studies evaluated how well the drugs protect the heart.

    Nonetheless, in an impassioned presentation to several thousand high blood pressure experts packed into a hotel ballroom, one of the researchers, Hans-Henrik Parving, MD, DMSc, shouted I call this victory! Parving is chief physician at the Steno Diabetes Center in Gentofte, Denmark.

    There is an epidemic of progressive disease in the United States, and it is due to type 2 diabetes, says Barry M. Brenner, MD, one of the study authors. If one lives for 15 years with type 2 diabetes, the number of complications looms very large. Brenner is a professor at Harvard Medical School.

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