How many of you were automatically prescribed a low dose ace inhibitor like lisinopril just because you have diabetes (without clinical hypertension)?
(They also want me to start statins next year at 40 even with very healthy lipids already just because of guidelines but that’s a subject for another day)
And of those how many experienced the famous lisinopril cough and had to switch to an ARB?
I’ve been haunted by a mystery cough that lasts for weeks many times over my life… most recently right around a year ago— when it became totally socially unacceptable to be coughing… I had been on lisinopril for about a year at that point— they said this is an extremely common side effect and switched me to Losartan, and it’s been gone since… but I’m wondering if I should try the lisinopril again and see if it re-occurs. There must be some reason they start everyone on an ace and only go to arb if it causes problems? Is the ace considered superior to those who don’t have side effects?
They automatically put me on lisinopril to protect kidneys and atorvastatin to protect the heart. I didn’t get a cough from lisinopril. It may have dropped my BP a little. The statin took reasonable lipids down to 70 LDL and 65 HDL which supposedly is significantly protective. Both of those medicines made me dizzy, but I acclimated after about a year.
They start with the ace because it has the most positive data supporting it. If you can’t tolerate, then an ARB is a good substitute, but there isn’t as much data. With that being said, women after a heart attack are usually started on the ARB first because of study data. Both target the same part of the renin angiotension II system, but the ace has a nice side effect of relaxing the blood vessels. Unrelated, but kind of like the nice side effect of beta blockers being mentally calming.
I think I may try the lisinopril again just as an experiment. I didn’t have any problem with the cough until I got sick with some sort of virus then the cough just never went away until I stopped taking them
I asked my endo to use lisinopril after learning here on FUD that it should help to protect kidneys for T1s. She said my blood pressure could be too low for it though. So she advised against taking it. I would just make sure your blood pressure does not drop too while on it.
The collaborative study found that in patients with overt nephropathy of type 1 diabetes, ACE inhibition with captopril induced a clear reduction in proteinuria, as compared with treatment not directly interfering in the RAS. The antiproteinuric benefit of captopril was associated with a slower decline in creatinine clearance and a reduction of the primary end point “doubling of serum-creatinine” of approximately 50% (8).
The European Microalbuminuria Captopril Study showed that in microalbuminuric patients with type 1 diabetes, ACE inhibition decreases the risk to develop overt nephropathy by approximately 75% (15), which proves that ACE inhibition has beneficial renal effects also at the earlier stage of incipient nephropathy. This is clinically important because microalbuminuria is a strong predictor of overt nephropathy and cardiovascular morbidity (16).
Renoprotective effects of ARB
Nondiabetic Renal Disease and Type 1 Diabetes.
Large-scale trials on the long-term renoprotective effect of ARB in nondiabetic and type 1 diabetic renal disease are missing so far.
I think a doctor mentioned prophylactic dosing of an ACE inhibitor sometime in the past. I’ve never been on one. I’ve been diabetic for 17 years, ages 28 to present 45.
As I think about it further, it was about 10 years ago when my A1C crept up to about 6.5, and microalbumin issues appeared on the labs, that the doctor made that suggestion. Subsequent labs and A1C s have shown no problems.
I’ve probably asked this here before, but what are benefits and costs of ACE inhibitor therapy? Is it necessary to use one if A1Cs are in the normal range?
No one can actually answer that type of question for an individual person, and few if any studies include enough diabetics with A1cs in normal ranges (esp T1s) to even answer that in terms of whether it seems to alter risk for samples or populations.
I would never say it is necessary. ACE inhibitors have been shown to have kidney protective effects, do you need that? Only you and your personal risk profile in consultation with a properly educated physician can answer that. My contribution to this would be that ACE inhibitors have been studied for a long time with known benefits and side effects. If you can tolerate a therapeutic dose and the side effects (if any) don’t bother you why wouldn’t you?