Curbside Consults

VOL 117 / NO 1 / JANUARY 2005 / POSTGRADUATE MEDICINE

ACE inhibitor for a diabetic patient with normal blood pressure?

Q: Should I prescribe an angiotensin-converting enzyme (ACE) inhibitor to a diabetic patient with normal blood pressure?

Primary care physician, Morocco

A: An ACE inhibitor should not be prescribed to a person with diabetes who has normal blood pressure (<120/80 mm Hg) even if he or she has microalbuminuria. The priority in such patients is glucose control (hemoglobin A_1c, <7%) and lipid management (low-density lipoprotein cholesterol, <70 mg/dL) (1).

If microalbuminuria is present, it is indicative of an inflammatory process, as is evident by recent data linking it to elevations in C-reactive protein (2). If blood pressure is 130/80 mm Hg or higher, an ACE inhibitor or, alternatively, an angiotensin II receptor blocker should be given to lower blood pressure to less than 130/80 mm Hg (3).

George L. Bakris, MD
Professor, Departments of Preventive Medicine and Internal Medicine
Rush Hypertension Center
Rush-Presbyterian-St Luke's Medical Center
Chicago

References

1. Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004;110(2):227-39
2. Stuveling EM, Hillege HL, Bakker SJ, et al. C-reactive protein and microalbuminuria differ in their associations with various domains of vascular disease. Atherosclerosis 2004;172(1):107-14
3. Summary of revisions for the 2004 clinical practice recommendations. Diabetes Care 2004;27(Suppl 1):S1-146

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