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SadieKatie

Is Lisinopril really necessary?!

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SadieKatie

A family member of mine has had diabetes for 2 years (type one). One of his doctors wants to place him on Lisinopril, 5 mg for "kidney protection" in spite of his BP being normal, always systolic 100-120, diastolic 60-80. His diet and exercise habits are also great; he controls his BG levels very well on insulin injections and would like to avoid unnecessary meds.

My question is this, how does an ace inhibitor like Lisinopril protect your kidneys if your blood pressure is already fine? From what I understand, all an ace inhibitor really does to lower your BP, and it's the high blood pressure that will damage your kidneys. If you don't have high blood pressure, why take the drug, and suffer unneeded side effects? Does it have some magical effects other than lowering your blood pressure that will help prevent kidney failure in the future?

 

I am not against medications in general. They are certainly life-savers for the right people. And of course I want what's best for my loved one. I don't want him to have compromised kidney function later in life when he could have prevented it. However I am aware of the negatives involved with regular medication use, and the possibility that, over time, drugs can actually damage the organs that they are trying to help.

 

I really need some reasonable and thorough thoughts about this. I am really tired of hearing "it's to protect your kidneys" from drug-pushing docs without a good scientific explanation why.

 

If drugs are the answer, are there "kidney protectors" with fewer negative health effects than Lisinopril?

 

I am new to this forum; thank you so much for your answers, I really appreciate it.

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MMJ

After reading this forum for 1.5 years, I have discovered that many here are very knowledgeable about diabetes and many other topics. I'm also very concerned that many offer advice about medications. It's one thing to get advice in a public forum like this pertaining to foods and general questions and it's another to get advice about medications. Please find a trained medical person or even 2 or 3 to get answers to these types of questions. Just my two cents worth!!

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Bountyman

When your family member told you their doctor was putting them on 5mg of Lisinopril, did you ask them if they asked the doctor why he was doing that? Because if a doctor was going to prescribe a new drug for me...it just begs the question "why?".

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ljjhouser

Hi Katie,

Welcome to the Forum.

A lot of people take lisinopril. I do also. I am not sure the problem with kidneys in diabetes patients is an issue of high blood pressure alone.

Two types of drugs, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease. Many people require two or more drugs to control their blood pressure. In addition to an ACE inhibitor or an ARB, a diuretic can also be useful. Beta blockers, calcium channel blockers, and other blood pressure drugs may also be needed.

 

An example of an effective ACE inhibitor is lisinopril (Prinivil, Zestril), which doctors commonly prescribe for treating kidney disease of diabetes. The benefits of lisinopril extend beyond its ability to lower blood pressure: it may directly protect the kidneys’ glomeruli. ACE inhibitors have lowered proteinuria and slowed deterioration even in people with diabetes who did not have high blood pressure.

 

An example of an effective ARB is losartan (Cozaar), which has also been shown to protect kidney function and lower the risk of cardiovascular events.

 

I have never had high blood pressure and was put on lisinopril the day I was dx'd.

 

I also take metotrolol. It is a beta blocker and will be even more effective in lowering blood pressure because it protects the heart from overactivity and stress. I was prescribed it after I had stents.

 

I found the above information at:

Kidney Disease of Diabetes

 

I have not side effects from either metoprolol or lisinopril.

 

Of course, these are questions best answered by your doctor before you make any decision. Your doctor should be able to help you access any risks involved and balance of need against any possible side effects.

 

Again, Welcome to the Forum. Glad you are here. Later, Larry

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MMJ

Sorry to hijack your thread Sadie but it really bothers me that people on here offer up advice about medications. A reader uneducated about these things might decide to stop his/her blood pressure medication because he read in here that it was bad medicine. The forum administrators will boot you off from here if a reader is offended by a weight comment but allow all types of medical advice to go thru here. Personally, I'm offended by it.

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yannah
Sorry to hijack your thread Sadie but it really bothers me that people on here offer up advice about medications. A reader uneducated about these things might decide to stop his/her blood pressure medication because he read in here that it was bad medicine. The forum administrators will boot you off from here if a reader is offended by a weight comment but allow all types of medical advice to go thru here. Personally, I'm offended by it.

 

Look, we are not prescribing on this forum. we are offering the valuable opinions and advice of expereince. anyone who is making desicions about medicine, usually is not asking for the definitive be all end all knowledge of other diabetics alone. usually one is gathering imput from several sources. but seeing what other people who actually ave the disease are doing is a really good idea.

 

that being said. I am drug phobic, but I take the quinipril. to me, I think its a good idea. kidney damage is a real risk here and I beleive that an ace inhibitor does help.

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SadieKatie

Thank you for your reply. I understand that most people on this forum are not doctors, and I will seek more than one professional's advice about my questions. However, I do really appreciate everyone's opinion and comments.

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musique913

I'm on it for kidney protection as well, 5mg. It's not dangerous and it definitely has been studied to help.

 

I researched it too when I was put on it, I wouldn't worry too much.:)

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SadieKatie
Hidden

Thank you, I was wondering if lisinopril provided some other benefit. Now I will know what to ask about.

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inkvisitor

It's always important to remember to not take someone's personal experiences with medication as anything more than that. Like the favorite phrase here goes, Your Mileage May Vary - actually, it probably will!

 

That being written, my experience was this: I was prescribed Lisinopril 10mg daily having normal blood pressure. I had to stop it completely after a couple weeks because my blood pressure would get too low. Next time I go to the doctor, though, I'm going to see what other options may be available..

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imac

I have failed kidneys and I am on dialysis and the renal specialist told me that high blood pressure is the main cause of kidney failure.

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jswede1149
Thank you for your reply. I understand that most people on this forum are not doctors, and I will seek more than one professional's advice about my questions. However, I do really appreciate everyone's opinion and comments.

 

Did your family member in question find out what her/his GFR was? A GFR tells the physician how a persons kidneys are functioning.

 

It is possible said relatives GFR revealed they are heading towards kidney issues.

 

I second advice here for this patient to become more proactive in their care and ask questions.

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sarahlee29

The doctor put me on Lisinopril for those exact reasons. One to protect my kidneys and two to help lower my blood pressure because mine is a little high for their liking (and mine as well)

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janice21475

My Dr. gave it to me to lower my BP (5 mg) = it made me cough. So, I am not taking any medications. I have since begun eating celery daily and my BP is now 109/62/83 first thing in the AM. After strenuous exercise 136/75/128 and it drops back to normal very quickly.

 

My husband (Diagnosed type 2) was given 2.5 mg a day, 'for his kidneys.' It has not made him cough and he still takes it.

 

I think the patient, or a representative should ask why they were given it.

 

Janice

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plattb1

I will echo the experience of other posters. I am taking ramipril & have taken it since diagnosis more than ten years ago. I have never had high blood pressure, either, and when I questioned the necessity of an additional drug, I was told that ACE inhibitors may prevent and control diabetic nephropathy (kidney disease) and help control diabetic retinopathy (eye problems). My endo says that "the pril sisters" (lisopril, ramipril, etc.) are necessary to protect my kidneys by preventing the body from producing the hormone angiotensin II. Angiotensin II causes vasoconstriction (narrowing of blood vessels.)

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foxl

One other thing -- my retinologist whom I saw in Sept observed hypertensive arterial stenosis (ie artery narrowing). I had been on Ramipril one month then. My Endo put me on it based on one high reading. I had never read all that high before that.

 

My Optometrist also ran a scan last week -- and saw none. And my BP is running 110/70 ...

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foxl

And a third post -- does anyone know the names of the clinical studies showing that ACE inhibitors do protect the kidneys, in Diabetes?

 

I know I have read them! Where?

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plattb1
And a third post -- does anyone know the names of the clinical studies showing that ACE inhibitors do protect the kidneys, in Diabetes?

 

I know I have read them! Where?

 

AACE Diabetes Practice Guidelines cites:

 

Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy [erratum in Lancet. 2000;356:860]. Lancet. 2000;355:253-259.

 

UK Prospective Diabetes Study (UKPDS) Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38 [erratum in BMJ. 1999;318:29].

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inkvisitor

More useless information for your reading pleasure (:T)

 

J Hypertens. 2009 Jul;27 Suppl 5:S15-21.

Effects of angiotensin II receptor blockers on diabetic nephropathy.

 

Kalaitzidis R, Bakris GL.

 

Hypertensive Diseases Unit, University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637, USA.

 

Impaired kidney function increases the risk of cardiovascular morbidity and mortality. Coexistence of hypertension and type 2 diabetes increases the risk of kidney damage, hypertension being an independent risk factor for kidney disease progression. Angiotensin II, through its inflammatory, proliferative, and thrombotic effects, adversely affects renal perfusion and increases oxidative stress, thus playing a pivotal role in kidney disease progression. Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors improve markers of kidney disease and slow kidney disease progression in diabetic and nondiabetic patients; this kidney protection may be in addition to their antihypertensive activity in those with advanced proteinuric nephropathy. Key beneficial effects of ARBs and ACE inhibitors throughout the kidney disease continuum are primarily explained by blood pressure lowering effects and partially by their direct blockade of angiotensin II. Recent studies have shown that telmisartan, an ARB with high lipophilicity and the longest half-life compared with other ARBs, provides benefits on markers of cardiovascular risk, that is, microalbuminuria and slowing of early-stage nephropathy.

 

Am Heart J. 2009 Jun;157(6 Suppl):S7-S16.

Complementary effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in slowing the progression of chronic kidney disease.

 

Ripley E.

 

Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298-0565, USA. eripley@mcvh-vcu.edu

 

Chronic kidney disease (CKD) and end-stage renal disease continue to pose major healthcare challenges. Early initiation of therapy aimed at slowing the progression of CKD is essential. Increased renin-angiotensin-aldosterone-system activity and, in particular, elevated levels of angiotensin II (AII) play important roles in the development and progression of CKD. Therefore, pharmacologic therapies that block the effects of AII and reduce its pathogenic effects are cornerstones of clinical management. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been shown to have renoprotective effects in addition to their ability to control blood pressure. There is accumulating clinical evidence that the combination of an ACEI and an ARB provides greater renal protection, particularly in decreasing proteinuria, than does either agent alone.

 

Nat Clin Pract Cardiovasc Med. 2008 Jul;5 Suppl 1:S36-43.

Reduction of proteinuria with angiotensin receptor blockers.

 

Galle J.

 

Department of Nephrology and Dialysis at Klinikum Lüdenscheid, Lüdenscheid, Germany. j.galle@klinikum-luedenscheid.de

 

Renal pathophysiology is elicited by activation of angiotensin II type 1 (AT(1)) receptors at all stages of renovascular disease. Angiotensin receptor blockers (ARBs) that specifically block the AT(1) receptor offer the potential to prevent or delay progression to end-stage renal disease independently of reductions in blood pressure. Proteinuria--an early and sensitive marker for progressive renal dysfunction--is reduced by ARB use in patients with type 2 diabetic nephropathy and microalbuminuria or macroalbuminuria. Retrospective analysis of data available from early trials has confirmed this finding and has shown that albuminuria reduction is associated with lessening of cardiovascular risk. The ARB telmisartan is equivalent to enalapril in preventing glomerular filtration rate decline, and equivalent to valsartan in reducing proteinuria. Telmisartan is more effective than conventional therapy in lowering the risk of transition to overt nephropathy in hypertensive and normotensive patients. An additive effect has been seen in smaller studies when telmisartan has been added to lisinopril therapy, and high-dose telmisartan reduces albuminuria better than low-dose telmisartan. Similar data were obtained with other ARBs such as candesartan, losartan, valsartan, or irbesartan. These data support the proposition that blockade of the renin-angiotensin system beyond that required for maximum blood pressure reduction provides optimum renal protection.

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BRTY0708

I take lisinopril and was given to me when I was diagnosed. I was a bit sick at first but once my body got use to it, I've been fine. I am not a doctor but seeing that your kidneys is what clean your body out sorta speak, and you have all these different medicines it now has to filter, anything that helps it to keep functioning and not get damaged is a plus for me.

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