Why Do I Take an ACE Inhibitor?
I have had type 1 diabetes for 40 years and I am in good health. I've been on the insulin pump for 10 years. My last A1C was 7.8, which was high for me. Why do I need to take an ACE inhibitor? I have been taking one for 12 years. I do not have high blood pressure or any heart problems. The side effects for me are dry mouth, skin rash, and headaches, and the medication just doesn't seem to be worth it. Please provide some perspective. While I respect my doctor, I haven't gotten a satisfactory explanation as to why I am taking it. Jill Derby, Tucker, Georgia
Roger Austin, MS, RPh, CDE, responds: Angiotensin-converting enzyme (ACE) inhibitors are a class of blood pressure—lowering medications that have a wide variety of therapeutic uses. In addition to controlling blood pressure, they are used in a number of heart conditions, including heart failure, coronary disease, and heart attacks. They also are used in cerebrovascular disease, and have particular application in diabetes because of their role in preventing and treating diabetic kidney disease.
Since you don't have high blood pressure or any heart problems, you should discuss the status of your kidney function with your physician. ACE inhibitors are first-line medications in treating microalbuminuria, which is the leakage of small amounts of protein into the urine. It is one of the first signs that your kidney function may be declining as a result of sustained high blood glucose levels, high blood pressure, or both. ACE inhibitors can be used for this purpose—for people with either type 1 or type 2 diabetes—even if the patient's blood pressure is normal. It has been said that the ACE inhibitors have a "protective effect" on the kidneys because of the way they affect blood flow to and from the kidneys. Like all medications, ACE inhibitors can cause side effects, which you describe in your letter. Since there are many different ACE inhibitors on the market, ask your doctor about trying a different one, which may not cause the side effects you describe. Another alternative is to use an angiotensin-2 receptor blocker (ARB), which can be used in patients who may not tolerate ACE inhibitors. ARBs also have protective effects on the kidneys.