The Use of ACE Inhibitors

The Use of ACE Inhibitors

ACE inhibitors, are drugs normally used for the treatment of high blood pressure. This is a category of drugs called Angio-Converting Enzyme inhibitors – ACE for short. ACE is an enzyme found in our bodies which activates a hormone called angiotensin causing the blood vessels to constrict, so raising blood pressure and putting pressure on the heart. ACE inhibitors prevent the action of angiotensin resulting in a lowering of blood pressure. However, there is evidence that the use of ACE inhibitors in people who start to show small amounts of protein in the urine, helps to reduce the progression to macroalbuminuria. In other words the use of ACE inhibitors has a protective effect on the kidneys, even in people whose blood pressure is normal.

What does the research show?
A meta-analysis [Ann Intern Med 2001 March ; 134[5] 370-9] was published on this subject. This is an analysis of studies to provide better evidence than just looking at individual studies. In this case, the studies were selected on the following basis:

1. They included at least 10 people with Type 1 diabetes who had microalbuminuria and normal blood pressure.
2. They had a control group who were not treated with ACE inhibitors [placebo group]
3. They had follow up results at least a year later.

12 studies were selected with a total of 698 patients. The results showed:

• The progression to macroalbuminuria was reduced in patients receiving ACE inhibitors.
• After two years the albumin excretion rate was 50.5% lower in treated patients than in those receiving a placebo [no treatment].
• For patients with normal blood pressure, Type 1 diabetes and microabluminuria, ACE inhibitors significantly reduced progression to macroalbuminuria and also increased the chances of regression back to normal where no proteins were found in the urine.
• The beneficial effects of ACE inhibitors were weaker at lower levels of protein excretion.

This has lead to some debate amongst the medical profession about when ACE inhibitors should be prescribed and to whom. While there are differing views on the use of ACE inhibitors to protect the kidneys, it is clear that early detection and early intervention is the way to prevent, treat and even regress problems with protein in the urine. The debate appears to be centred around whether or not people with diabetes should start taking low dose ACE inhibitors before there is any sign of protein in the urine or raised blood pressure to try to prevent the development of microalbuminuria. If people who are at risk of developing kidney disease can be identified, then there appears to be is a case for prescribing ACE inhibitors for these people.

Note: ACE inhibitors can have fairly mild side effects, the common one being an irritating cough. They are not suitable for everyone and so this needs to be discussed with your doctor. They are not recommended for pregnant women.