ACE inhibitors beneficial in type 2 diabetes

NEW YORK (Reuters Health) - Results of a study indicate that patients with high blood pressure and type 2 diabetes benefit from taking an angiotensin-converting-enzyme (ACE) inhibitor to lower blood pressure, even if they have no evidence of kidney or heart disease.

Use of ACE inhibitors, and control of hypertension (high blood pressure), appears to have independent and additive protective effects in patients with type 2 diabetes, suggest early data from a large Italian study known as the BENEDICT trial.

In the study of 1180 type 2 diabetic patients with hypertension, treatment with the ACE inhibitor trandolapril, or trandolapril combined with another BP lowering drug called verapamil (Veratran), delayed the onset of "microalbuminuria" -- a build-up of the blood protein albumin in the urine that can signal kidney disease. Diabetes is a leading cause of kidney disease.

According to Dr. Piero Ruggenenti and colleagues at "Mario Negri" Institute for Pharmacological Research in Bergamo, Italy, "effective BP reduction has a specific and independent protective effect against the development of microalbuminuria."

Systolic BP itself was the strongest predictor of microalbuminuria, and its reduction was the most protective factor.

Moreover, the researchers found, "ACE inhibitor therapy has a further protective effect, in particular when the BP is poorly controlled."

On the other hand, Veratran was most effective in reducing systolic BP. This agent was less likely to require concomitant treatment with other heart drugs like diuretics and beta blockers.

Ruggenenti's team concludes that BP reduction, and not just less severe baseline hypertension, protects against the development of kidney damage.

SOURCE: Journal of the American Society of Nephrology, December 2006.