Would a Blood Pressure Medication Help?
My 28-year-old son has had type 1 diabetes since he was 14. A health care provider recently prescribed Lisinopril, a blood pressure medication, saying it had been shown to help people with diabetes protect their kidneys. My son's A1Cs are usually in the 7 percent range, and he is apprehensive about starting on a new medication. Does it help? What are the risks of not taking it? Kim Fechik, Grand Blanc, Michigan
Roger P. Austin, MS, RPh, CDE, responds:
Thank you for asking—protecting the kidneys is an important part of living well with diabetes, and the American Diabetes Association hopes to raise awareness of the issue. Kidney damage (also called nephropathy) occurs in 20 to 40 percent of people with diabetes and is the single leading cause of end-stage renal disease (ESRD).
What to Know:
Low levels of albumin in the urine (called microalbuminuria) have been shown to be the earliest stage of diabetic nephropathy in patients with type 1 diabetes. Microalbuminuria is also a marker of increased risk for cardiovascular disease (heart attack and/or stroke).
Microalbuminuria is detected by a simple urine test called the albumin-to-creatinine ratio. This test can show whether small amounts of albumin are present in the urine, indicating that steps are needed to avoid further kidney damage.
Lisinopril belongs to a class of blood pressure medications called angiotensin-converting enzyme inhibitors (ACE inhibitors or ACE-Is). The ACE inhibitors are especially effective in delaying the progression of diabetic nephropathy, even if the person with microalbuminuria does not have high blood pressure.
Find Out More:
Your son may want to ask his doctor if the test for microalbuminuria has been done and how the doctor has interpreted the results. The test is recommended once a year for all people with type 2 diabetes and for people who have lived with type 1 diabetes for five years or more. The healthy target is less than 30 mg/g.
The combination of good blood glucose control (as evidenced by your son's A1C of 7 percent) and good blood pressure control is particularly effective in reducing the progression of diabetic nephropathy.