Drugs

, Volume 39, Supplement 2, pp 33–39 | Cite as

Angiotensin-Converting Enzyme (ACE) Inhibition

Therapeutic Option for Diabetic Hypertensive Patients
  • Maria Teresa Zanella
  • Bernardete J. L. Salgado
  • Osvaldo KohlmannJr
  • Artur B. Ribeiro
Clinical Studies

Summary

When choosing antihypertensive agents for the treatment of diabetic patients with hypertension, it is necessary to consider the individual characteristics of these patients. In this respect, angiotensin-converting enzyme (ACE) inhibitors constitute an attractive option for diabetic patients.

The effects of enalapril alone for 16 weeks in 23 non-insulin-dependent diabetic (NIDD) patients and in 10 non-diabetic patients with mild to moderate essential hypertension (EH) [diastolic blood pressure > 95mm Hg and < 115mm Hg] were evaluated. Similar reductions in both systolic and diastolic blood pressure were observed in 17 NIDD patients (from 155 ± 18/100 ± 11mm Hg to 128 ± 12/82 ± 8mm Hg, respectively) and in 6 EH patients (from 155 ± 21/100 ± 6mm Hg to 125 ± 20/84 ± 8mm Hg, respectively) who achieved and maintained blood pressure control (diastolic blood pressure < 90mm Hg) for 16 weeks. In 4 NIDD and 4 EH patients blood pressure was not controlled. Two NIDD patients discontinued the medication, one because of symptomatic postural hypotension and the other, who had a plasma creatinine level of 1.8 mg/dl, because of hyper-kalaemia (K = 6.1 mEq/L).

In the responders, enalapril did not alter glucose tolerance, plasma or urinary excretion of creatinine, potassium, sodium and aldosterone. Plasma renin activity increased in the NIDD group only. In 11 patients (6 NIDD and 5 EH), the elevated protein or albumin excretions decreased. It is concluded that enalapril is a good therapeutic option for NIDD patients with hypertension.

Resumen

Al escoger los agentes antihipertensivos para el tratamiento de pacientes diabéticos con hipertensión, es necesario considerar las características individuales de dichos pacientes. Por lo que a esto respecta, los inhibidores de la enzima transformadora de angiotensina (ACE) constituyen una opción atractiva para pacientes diabéticos.

Se evaluaron los efectos del enalapril por sí solo durante 16 semanas en 23 pacientes diabéticos no dependientes de insulina (NIID) y en 10 pacientes no diabéticos con hipertensión esencial de suave a moderada (EH) [presión sanguínea diastólica > 95mm Hg y < 115mm Hg]. Se observaron reducciones similares de la presión sanguinea sistólica y diastólica en 17 pacientes NIID (de 155 ± 18/100 ± 11mm Hg a 128 ± 12/82 ± 8mm Hg, respectivamente) y en 6 pacientes EH (de 155 ± 21/100 ± 6mm Hg a 125 ± 20/84mm Hg, respectivamente), y todos lograron y mantuvieron el control de la presión sanguinea (presión sanguínea diastólica < 90mm Hg) durante 16 semanas. No se controló la presión sanguínea de 4 pacientes NIID, ni de 4 pacientes EH. Dos pacientes NIID dejaron de recibir la medicación, uno a causa de hipotensión postural sintomática y otro, que tenía un nivel de creatinina plasmóatica del 1,8 mg/dl, a causa de hipercalcemia (K = 6, 1m Eg/L).

En los pacientes que respondieron, el enalapril no alteró la tolerancia a la glucosa, el plasma o la excreción urinaria de creatinina, potasio, sodio o aldosterona. La actividad de la renina plasmática aumentó sólo en el grupo NIID. En 11 pacientes (6 NIID y 5 EH) las excreciones elevadas de proteína o óalbumina disminuyeron. Se llegó a la conclusión de que el enalapril es una buena opción terapóeutica para pacientes con hipertensión.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Atlas SA, Case DB, Sealey JE, Laragh JH, McKinstry DN. Interruption of the renin angiotensin system in hypertensive patients by captopril induces sustained reduction in aldoster-one secretion, potassium retention and natriuresis. Hypertension 1: 274–280, 1979PubMedCrossRefGoogle Scholar
  2. Christensen CK. Rapidly reversible albumin and beta-2-micro-globulin hyperexcretion in recent severe essential hypertension. Journal of Hypertension 1: 45–51, 1983PubMedCrossRefGoogle Scholar
  3. Christensen CK, Mogensen CE. Effect of antihypertensive treatment on progression of incipient diabetic nephropathy. Hypertension 7 (Suppl. II): II109–II113, 1985PubMedCrossRefGoogle Scholar
  4. Christlieb AR. Diabetes and hypertensive vascular disease. American Journal of Cardiology 32: 592–606, 1973PubMedCrossRefGoogle Scholar
  5. De Fronzo RA, Felig P, Ferranini E, Wahren J. Effect of graded doses of insulin on splanchnic and peripheral potassium metabolism in man. American Journal of Physiology 238: E421–E427, 1980Google Scholar
  6. Engvall E, Rvoslahtt E. Principles of ELISA and recent applications to the study of molecular interactions. In Nakamura RM, et al. (Eds) Immunology clinical laboratory, pp. 89–97, Alan R. Liss, New York, 1979Google Scholar
  7. Gambaro G, Morliato F, Cicerello E, Del Turco M, Sartori L, et al. Captopril in the treatment of hypertension in type I and type II diabetic patients. Journal of Hypertension 3 (Suppl. S2): S149–S151, 1985PubMedGoogle Scholar
  8. Gavras H, Biollaz J, Waeber B, Brunner HR, Gavras I, et al. Antihypertensive effect of the new oral angiotensin converting enzyme inhibitor “MK-421”. Lancet 2: 543–546, 1981PubMedCrossRefGoogle Scholar
  9. Langan J, Jackson R, Adlin EV, Chammich BJ. A simple RIA for urinary aldosterone. Journal of Clinical Endocrinology Metabolism 38: 189–193, 1974PubMedCrossRefGoogle Scholar
  10. Lanza G, Barbera R, Fontana S. Captopril as treatment of hypertension in diabetics. Minerva Medica 76: 183–184, 1985PubMedGoogle Scholar
  11. Mallia AK, Hermansen GT, Khrohn RI, Fujimoto EK, Smith PK. Preparation and use of a boronic acid affinity support for separation and quantification of glycosylated hemoglobins. Analytical Letter 14: 649–661, 1981CrossRefGoogle Scholar
  12. Mogensen CE. Preazotemic diabetic nephropathy, inhibited by antihypertensive treatment. In Friedman EA, L’Esperance FA (Eds) Diabetic renal-retinal syndrome, pp. 183–196, Grune & Stratton, Florida, 1980Google Scholar
  13. Murphy MB, Lenvis PJ, Kohner E, Schumer B, Dollery CT. Glucose intolerance in hypertensive patients treated with diuretics: a fourteen-year follow up. Lancet 2: 1293–1295, 1982PubMedCrossRefGoogle Scholar
  14. Oestman J. Beta-adrenergic blockade in diabetes mellitus. A review. Acta Medica Scandinavica 672 (Suppl.): 69–77, 1983Google Scholar
  15. Rosenstock J, Loizou SA, Brajkovich IE, Mashiter K, Joplin GF. Effect of acute hyperglycemia on plasma potassium and aldosterone levels in type 2 (non-insulin-dependent) diabetes. Diabetologia 22: 184–187, 1982PubMedCrossRefGoogle Scholar
  16. Todd PA, Heel RC. Enalapril. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in hypertension and congestive heart failure. Drugs 31: 198–248, 1986Google Scholar
  17. Vieira JGH, Noguti KD, Russo EMK, Maciel RMB. Radioimmunoassay for plasma renin activity: methodologic aspects. Revista Brasileira de Patologia Clinica 17: 195–200, 1981Google Scholar
  18. Weidmann P, Beretta-Piccoli C, Trost BN. Pressor factor and responsiveness in hypertension accompanying diabetes mellitus. Hypertension 7 (Suppl. II): II33–II42, 1985PubMedCrossRefGoogle Scholar
  19. Zanella MT, Bravo EL, Fouad FM, Tarazi RC. Long term converting enzyme inhibition and sympathetic nerve function in hypertensive humans? Hypertension 6 (Suppl. II): II216–II221, 1981Google Scholar
  20. Zanella MT, Matter Jr E, Draibe SA, Kater CE, Ajzen H. Inadequate aldosterone response to hyperkalemia during angiotensin converting enzyme in chronic renal failure. Clinical Pharmacology and Therapeutics 38: 613–617, 1985PubMedCrossRefGoogle Scholar
  21. Zatz R, Dunn BR, Meyer TW, Anderson S, Rennke HG, et al. Prevention of diabetic glomerulopathy by pharmacological amelioration of glomerular capillary hypertension. Journal of Clinical Investigation 77: 1925–1930, 1986PubMedCrossRefGoogle Scholar

Copyright information

© ADIS Press Limited 1990

Authors and Affiliations

  • Maria Teresa Zanella
    • 1
  • Bernardete J. L. Salgado
    • 1
  • Osvaldo KohlmannJr
    • 1
  • Artur B. Ribeiro
    • 1
  1. 1.Nephrology and Endocrinology DivisionEscola Paulista de MedicinaSao PauloBrazil

Personalised recommendations