Lisinopril for diabetes

Diabetes can be life-threatening and is a disease that needs to be monitored.

There are some medications that are used to help mitigate the long-term effects of diabetes – one of these is lisinopril for type 2 diabetes.

Diabetes is a disease that affects more people than meets the eye.

According to the Centres for Disease Control & Prevention (CDC), as of 2018 34.2 million Americans were living with diagnosed and pre-diagnosed diabetes,¹ 10.5% of the U.S. population.

2019 analysis by Diabetes Canada

A 2019 analysis by Diabetes Canada reported that 11 million Canadians had diabetes or prediabetes.² That’s 29% of the total Canadian population.

With such a high proportion of the population facing diabetes, understanding how to adapt and conquer the adverse effects of the disease is incredibly important. 

Lisinopril for diabetes

Lisinopril is a medication that is used for the treatment of hypertension or high blood pressure. It is part of a family of angiotensin-converting enzyme (ACE) inhibitors commonly prescribed to diabetics.

ACE normally converts a protein called angiotensin I into angiotensin II in the blood, which causes blood vessels to tense and increases blood pressure.

ACE inhibitors, like lisinopril, prevent angiotensin II from being produced.

This effect of ACE inhibitors allows blood vessels to relax, lowering blood pressure. 

How does lowering blood pressure treat diabetes? 

People with diabetes have an increased risk of developing life-threatening illnesses, however, lowering blood pressure may help mitigate these risks.

Studies from the U.K. and from the U.S.

One study from the U.K. and another from the U.S. found a direct relationship between systolic blood pressure and mortality, cardiovascular disease, and nephropathy (kidney disease) in patients with type 1 and type 2 diabetes.^3,4

So, lowering blood pressure in diabetics may be a key treatment target.  

Cardiovascular Disease

Cardiovascular disease is the leading cause of death in those with diabetes mellitus,⁵ actually causing 86% of deaths in diabetics.⁶

People with diabetes are up to three times more likely to have high blood pressure than people who do not have diabetes.6

Hypertension could play a major role

Hypertension could play a large role in the onset of heart diseases like coronary artery disease and heart failure. 

One study found that lowering blood pressure actually had a larger effect on lowering the risk for cardiovascular complications than blood sugar control in diabetics.⁷

This group also showed that lowering the blood pressure of diabetics actually decreased their risk of stroke by 44%.⁷

A second study found that the rate of major cardiac events, such as heart attack and stroke, decreased 51% in diabetics with a diastolic blood pressure below 80mmHg compared to those with blood pressure between 85-90mmHg8. 

Lisinopril could have significant benefits for those with diabetes who are also at risk for cardiovascular complications. 

Kidney Failure

Kidney disease, or nephropathy, is another common side-effect of diabetes.

In fact, about 20-30% of type 1 diabetics and 10-20% of type 2 diabetics will develop end-stage kidney disease.

Having high blood pressure actually raises the incidence of kidney dysfunction and is a contributing factor to kidney failure.

A key sign of nephropathy

A key sign of nephropathy is elevated albumin excretion in urine.

One study looked at the effect of two different blood pressure treatment plans on the progression of diabetic nephropathy. They observed 36 patients with diabetic nephropathy over 42 months.

Some patients were given a conventional blood pressure drug called atenolol (a beta blocker) with a diuretic, while a separate group was given lisinopril.

After the duration of the study, the albumin excretion rate was 55% reduced in those treated with lisinopril compared to a 15% reduction observed in those treated with atenolol.10

Lisinopril then may be a more effective option than conventional blood pressure medications for those with diabetes and a high risk of developing nephropathy. 

Should I Choose an ACE Inhibitor or ARB?

Another type of medication used to treat high blood pressure for diabetic nephropathy is ARB.

ARB stands for angiotensin II receptor blockers which work to block the increased blood pressure effect of angiotensin II. 

A study that compared both medications

In a study that compared the effect of ACE inhibitors and ARB on diabetic nephropathy in type 2 diabetes, researchers found that those treated with an ARB had a lower risk of reaching end-stage kidney failure compared to those treated with an ACE inhibitor.11 

Lisinopril for diabetes is a viable option for lowering blood pressure and has the potential to lower the risk of cardiovascular disease and nephropathy.

Lisinopril and other ACE inhibitors have been shown to be more effective than conventional beta-blockers at lowering blood pressure but may be slightly less effective than an ARB.

With diabetes affecting millions in North America, understanding which medication works best for each individual should be a top priority to ensure health and longevity in the diabetic population.

It is important to speak with your doctor about which medication might be right for you.

References

1. National Diabetes Statistics Report 2020. (2020). U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 
2. Diabetes Cost Model. (2019). Diabetes Canada. Retrieved from https://www.diabetes.ca/media-room/press-releases/new-diabetes-rates-released-with-urgent-plea-for-governments-to-implement-national-diabetes-strategy.
3. Adler, A. I. et al. (2000). Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): Prospective observational study. British Medical Journal; 321(7258): 412-419. Doi: 10.1136/bmj.321.7258.412.
4. Orchard T.J. et al. (2001). Lipid and blood pressure treatment goals for type 1 diabetes: 10-year incidence data from the Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes Care; 24(6): 1053-1059. Doi: 10.2337/diacare.24.6.1053. 
5.  Laakso M. (1999). Hyperglycemia and cardiovascular disease in type 2 diabetes. Diabetes; 48(5): 937-942. Doi: 10.2337/diabetes.48.5.937.
6. Wingard D. L. et al. (1995). “Heart disease and diabetes”. Diabetes in America, 2nd edition. Washington, DC, U.S. Govt. Printing Office, 1995, p. 429–448 (NIH publ. no. 95-1468).
7. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. British Medical Journal; 317(7160): 703-713. 
8. Hansson L. et al. (1998). Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet; 351(9118): 1755-1762. Doi: 10.1016/s0140-6736(98)04311-6. 
9. Pavkov, M. E., et al. (1995). “Kidney disease in diabetes”. Diabetes in America, 2nd ed. National Diabetes Data Group. Washington, DC, U.S. Govt. Printing Office (NIH publ. no. 95-1468).
10. Nielsen, F. S. et al. (1997). Long-Term Effect of Lisinopril and Atenolol on Kidney Function in Hypertensive NIDDM Subjects With Diabetic Nephropathy. Diabetes; 46(7): 1182-1188. Doi: 10.2337/diab.46.7.1182. 
11. Robles, N. R. et al. (2009). Angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers for diabetic nephropathy: a retrospective comparison. Journal of the Renin-Angiotensin-Aldosterone System; 10(4): 195-200. Doi: 10.1177/1470320309352352.
12. Image by Arek Socha from Pixabay  

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