There are many potential benefits of treating your hypertensive patients who
have diabetes with a regimen that includes either an angiotensin converting
enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB) medication.
Because of these benefits, several national and international guidelines
recommend the use of ACEI/ARBs as anti-hypertensive agents when patients have a
diagnosis of diabetes, unless contraindicated or not clinically tolerated.
ACEI/ARB therapy has been shown to decrease the rate of progression of kidney
disease in patients who have diabetes, independent of their ability to lower
blood pressure. According to the American Diabetes Association?s Standards of
Medical Care in Diabetes ? 2013, the use of these drugs in this population
reduces cardiovascular morbidity and mortality, and if one class of medication
is not tolerated, the other should be substituted.
Although the majority of physicians are using ACEI/ARBs in their patients who
have hypertension and diabetes, physicians may sometimes choose to discontinue
ACEI/ARB therapy when a patient?s renal function begins to decline and serum
potassium levels start to rise, precisely the time when these medications may
be of the most use. It is important to note that ACEI/ARBs can often be used
safely and will improve renal outcomes in stable patients with diabetes, even
if they have poor renal function (GFR < 30mL/min).
Please consider the potential advantages of ACEI/ARBs for your hypertensive
patients who have diabetes. Most ACEI/ARBs are available generically. In
mid-June we will be adding a new Clinical Alert to assist you in identifying
members who may benefit from ACEI/ARB therapy. For instructions on how to
access Clinical Alerts for your patients, please review our Clinical Alerts
Overview, which is available in the Administrative Tools & Resources section of
IBC NaviNet[
]?[] Plan Central. If you have any questions, please
contact your Network Coordinator.
[
]References[
]
[
]Angiotensin Converting Enzyme Inhibitors. J Clin
Hypertension. 2011; 13(9): 667.
Efficacy and Safety of Benazepril and Advanced Chronic Renal Insufficiency. N
Eng J Med 2006; 354:131.
Executive Summary: Standards of Medical Care in Diabetes ? 2013. Diabetes Care,
Volume 36, Supplement 1, January 2013.
Renoprotective Effects of the Angiotensin Receptor Antagonist Irbesartan in
Patients with Nephropathy Due to Type 2 Diabetes. N Eng J Med 2001; 345(12):
851.[
]
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