question and answer
ACE inhibitors in controlled diabetes?
April 2010
If an individual with type 2 diabetes reduces their fasting blood sugar and Hgb A1c to “normal” with lifestyle changes alone, and also has normal BP, do they need to remain on an ACE inhibitor for renoprotection? Shahebina Walji, MD, Calgary, AB

If a diabetic patient has good control of diabetes (with or without medication), has “normal” blood pressure (< 130/80 mm Hg) and has no evidence of microalbuminuria (checked on 2 to 3 occasions), then there’s no indication for an ACE inhibitor for renoprotection. Having said that, the landmark 1999 HOPE study (NEJM 2000;342:145-53), 2000, which showed broad cardiovascular survival benefits for ACE inhibitors in a range of at-risk patients, yielded particularly promising results in the diabetic subgroup. So depending on the patient’s age (HOPE subjects were 55+ and averaged 66), there’s a strong argument that diabetic patients, and especially those with history of CVD or other CV risk factors, would benefit from an ACE inhibitor for cardiovascular protection.

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