BLOOD PRESSURE DRUGS PROTECT THE KIDNEYS
Diabetes mellitus ie. “sugar diabetes,” has numerous devastating manifestations. The worst of these is any of the serious problems that occur in the heart and the vascular system. Heart attacks, arrhythmias, heart failure, and arterial blockages of the limbs that lead to amputation are some of those complications. Not far behind heart and vascular problems, though, is chronic kidney disease, one the most frequent reasons patients need dialysis.
Diabetics also almost always have high blood pressure. Vascular inflammation (vasculitis) is the major underlying problem that contributes to causing high blood pressure and plays a significant role in causing damage to the kidneys. High blood pressure affects kidney function, too, so diabetics have plenty of reasons to have chronic kidney disease.
The good news is two classes of blood pressure medications actually have a protective effect on the kidney function of diabetics. The drug classes are ACE’s and ARB’s.
ACE’s are Angiotensin Converting Enzyme Inhibitors like lisinopril, captopril, accupril.
ARB’s are Angiotensin Receptor Blockers like losartan, irbesartan, olmesartan.
Diabetic kidney disease, or diabetic nephropathy, is divided into five stages based on a functional measurement called the Glomerular Filtration Rate, the GFR. The five stages of Chronic Kidney Disease based on GFR results are as follows:
Stage 1 GFR 90 or >
Stage 2 GFR 60-89
Stage 3a GFR 45-59
Stage 3b GFR 30-44
Stage 4 GFR 15-29
Stage 5 GFR less than 15
End Stage Renal Disease is the term given to patients whose kidney function has worsened to Stage 5 where “the kidneys have lost nearly all their ability to do their job effectively.” These patients eventually need dialysis or transplantation to live. To delay that outcome, doctors have learned ACE’s and ARB’s are associated with improved kidney outcomes in patients with diabetic kidney disease.
Doctors from Baylor College of Medicine in Houston reviewed 109 studies involving 28,341 patients with diabetic kidney disease and GFR’s greater than 15. What they learned from these studies is the following:
1. Compared to placebo, ARB’s prevented worsening of kidney function and the progression of a small amount of protein in the urine to large amounts of protein.
2. Compared to placebo, “ACE’s reduced overall progression to kidney failure,” and “prevented progression from micro-proteinuria to macro-proteinuria.”
3. Researchers could not determine which were more effective, ACE’s or ARB’s.
4. Family physicians who manage these patients are encouraged to prescribe ACE’s or ARB’s for diabetics with Chronic Kidney Disease and high blood pressure.
5. Neither ACE nor ARB therapy reduces all-cause or cardiovascular mortality compared to placebo.
BOTTOM LINE: ACE and ARB antihypertensive medications are protective of kidney function in diabetic patients and should be prescribed for these patients “to delay or prevent progression to kidney failure.” Ask you doctor about this and if an ACE or ARB is right for you.
REFERENCE: Sarkar A, Jarrett B, Rode R. ACE Inhibitor or ARB Therapy can prevent Diabetic Kidney Disease Progression Am Fam Phys 2025 January;111(1):24.
