Has there been any research on the use of ACE inhibitors for the prevention of kidney disease among pediatric T1s?
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Not that I am aware of, but I will take a look tomorrow.
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The anti-anxiety effects of beta-blockers is not exactly linked to blood pressure, so much as beta blockers work by dampening sympathetic nervous system reactivity broadly, aka your fight or flight system, which is what kicks in when people get anxious to make you feel your heart race, sweaty, shaky, pale, cold hands, stomach upset, etc. (It’s also what kicks in to make that happen when you’re low, so beta blocker use can mask hypo symptoms if they are not very strong for people—for me they help, because I get false positives without a beta blocker and think I’m low when I’m not.) Other blood pressure meds work differently and I do not believe have an anxiolytic effect (but accordingly, a different set of side effects, which for some people are more tolerable). Propranolol is ideal if a person is looking specifically for an anti-anxiety effect out of a beta-blocker because it has the greatest effect on the nervous system; however, I take atenolol for my tachycardia, and I noticed an anxiolytic effect of that too, so I think lots of them can still have that effect. Probably best to discuss with your doctor, who can factor in what purpose a beta-blocker would have for you. That said, it’s nice that there are a bunch of options, since if one doesn’t work, it’s possible another might.
Beta-blockers do not have the possible renal protective feature being discussed though, so if that’s a priority and your primary purpose is treating hypertension, an ACE inhibitor could make more sense.
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Imagine my suprise when I found this in the New England Journal of Medicine:
http://www.nejm.org/doi/full/10.1056/NEJMoa1703518?query=featured_home&
Short answer, ACE and Statins didn’t affect the albumin to creatinine ratio’s over time in adolescents. So while it may be an attractive idea, it didn’t pan out in the population. Of course, more study may be warranted.
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Fascinating:
We hypothesized that adolescents with high levels of albumin excretion might benefit from angiotensin-converting–enzyme (ACE) inhibitors and statins, drugs that have not been fully evaluated in adolescents.
[…] The primary outcome was not affected by ACE inhibitor therapy, statin therapy, or the combination of the two.
This is exactly the answer I was looking for: it is categorical. It works with adults but not with teens. I can’t help wonder why.
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Do we have studies showing it works with adults without high blood pressure? Maybe it’s just a blood pressure thing, and not specific to any age.
I’m really surprised about that teens study. My endocrinologist said they had done research shwoing lowering cholesterol in teenagers helped diabetes outcomes down the road (of course that’s a different study, I’m just now curious about it).
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Helllooooo! Wondering if anyone here has experience with longer term use of propranolol? My neurologist just prescribed it for me for migraine prevention, but also to tie in with elevated blood pressure (~136/90 and below) (I just bought myself a home BP monitor so that I can track changes if I decide to take the meds). I do also have a high resting heart rate at about 80 bpm.
I also just started back on an exercise regimen after being away from any form of physical activity for a year b/c of frozen shoulder (shoulder still frozen; I’m tired of being frozen!). We are strictly isolating so got a peloton and I’m using it every other day and trying to walk on the off days. I’m worried about BP going too low to get an effective workout. Also hesitant to add yet another med to the mix. Any thoughts would be appreciated. Thanks! Jessica
As far as I know, this is a totally normal resting heart rate. I have a high resting heart rate (inappropriate sinus tachycardia) and my understanding is an abnormally high resting heart rate is a heart rate that’s above 100 bpm for no reason.
I’ve taken beta blockers (propranolol and bisoprolol) on and off for years due to my heart rate. I also have high blood pressure, but my understanding is that these two medications don’t have much significant effect on blood pressure compared to other medications (I’m on two other blood pressure medications). I’ve recently stopped taking beta blockers because they can interfere with my EpiPen, should I ever need to use it.
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I have been on beta blockers (not propanolol) for many years. Propanolol has been used since the 60’s and is very well studied. So that is a big plus. Since your resting heart rate is at 80 you are much less likely to run into dosing issues where the drug is dragging your resting heart rate too low. I would still be using beta blockers to control my blood pressure if I didn’t run into the unfortunate male side effect. The beta blocker side effect I really liked is the reduced anxiety subtle but noticeable.
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I tried low dose beta blocker for bp… which apparently has mixed thoughts for insulin users because they say they can mask the symptoms of low bg. I did appreciate the anxiety reducing effects… my hr even on the lowest doses dropped down into the 40s though… which I wasn’t comfortable with. As for the male effects… I actually noticed an improvement in that regard for me
Lately I’ve been taking an ace… until I developed a cough (which I’ve had off and on seasonally for years and has never been properly diagnosed or treated) so they switched me to an arb… cough went away but I’m not convinced it wasn’t coincidental. My hc procider, who I trust, says I should take a statin but it’s up to me at this point until I turn 40 (2 years from now) at which point she’ll strongly recommend it
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I’ve taken beta blockers because of a really high heart rate in the past (average heart rate on a Holter test of well over 100) and even then, at times my heart rate would drop into the low 50s and it felt terrible. So I can imagine taking a beta blocker with a normal heart rate would be quite challenging.
A couple years ago I started on a new ACE inhibitor and developed an extremely irritating cough a few months later. I mentioned it to my doctor, but in the end the nine-month cough was related to allergies. I’m still taking the same medication today with no issues.
This is really dose dependent, so a small dose is very unlikely to push someone with a HR of 80 or 100 into the 50’s.
The cardiologist just put me on propranolol a couple weeks ago when it was discovered I have an arrhythmia. I do not have high blood pressure but I do have high cholesterol so am on Rosuvastatin for that.
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Reviving this topic as my blood pressure seems to be on the rise. It was elevated at my most recent endo appt (hmmm, duh?!) and I’ve been taking it at home. I can get it back in range if I sit and meditate, but regular life isn’t one zen meditation, is it?! From reading this, it seems like an ACE inhibitor might be a no-brainer to try, then an ARB if the ACE leaves me with a cough? (I have tried a beta blocker in the past for migraine prevention/relief and it did absolutely nothing for my blood pressure.) Thoughts? Thanks!
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When I turned 40 my doc wanted me to arbitrarily start ace or arb and a statin. Did so, no issues whatsoever…. Have to assume they recommend them for a reason. With diabetes I’ll take all the kidney and vascular protection I can get.
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I think the statin has more controversy than the blood pressure meds. Controlling your blood pressure is very important. Especially if you have a family history of strokes. There are many approaches to this, and I wouldn’t write off the beta blocker, they may have been using a really low dose for your migraines. Or of course it might not have worked for you. But I would definitely get your blood pressure into a healthy range.
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Which did you try, Sam? Ace/ARB? How’s it going?
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Thanks Chris. My cholesterol was creeping up and I did a deep dive with Eric on the why’s and whether it was truly necessary for me (it did seem to be). I am now on an every-other-day statin plan and my cholesterol #s have come down nicely. Had a good convo w Eric the other day (he seriously knows everything and can explain it well!) and I am ok giving the ACE a try. Just have to get in touch with the PCP and put the kibosh on all of the rigamarole surrounding all of it! Thanks for your input here! xo
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Glad to hear it. Eric is amazing as always. I personally have been on blood pressure and statins for a long time and they just work for me. I did have a journey through blood pressure meds due to side effects though. Ended up on an ace inhibitor plus hydrocholorothiazide.
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@Chris, any side effects on the ace or hydrochlor…?
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