ACE Inhibitors Not Always an Ace Treatment in Patients With Diabetes

I recently diagnosed type 2 diabetes mellitus in a 33-year-old man who has no diabeticsymptoms, proteinuria, or evidence of nephropathy. His blood pressure is low(100/60 mm Hg). Is an angiotensin-converting enzyme (ACE) inhibitor appropriatein this setting?---- Kiron Malhotra, MD
Melbourne, FlaBlood pressure control is the recommended treatment for preventionof diabetic nephropathy, and it is now considered standard-of-care toinclude ACE inhibitors or angiotensin receptor blockers in the antihypertensiveregimen. Your patient is mildly hypotensive; thus, an ACEinhibitor might well provoke a fall in blood pressure that could producesignificant symptoms. In addition, his low blood pressure might be symptomaticof underlying autonomic neuropathy, and an ACE inhibitor would certainlybe contraindicated in that setting.---- Rachmel Cherner, MD
Associate Clinical Professor of Medicine
Jefferson Medical College of Thomas Jefferson University
Philadelphia