Effects of Enalapril in Insulin-Dependent Diabetic Subjects With Mild to Moderate Uncomplicated Hypertension

Abstract

The antihypertensive efficacy of enalapril and its effects on the metabolism and kidney function were investigated in 11 insulin-dependent diabetic subjects with uncomplicated mild to moderate hypertension. During a short-term single-blind controlled trial, one daily dose of 20 or 40 mg enalapril significantly reduced both systolic and diastolic blood pressure. In the supine position, mean systolic blood pressure declined from 169 +/- 6 to 142 +/- 6 mmHg (P less than .01) and mean diastolic blood pressure from 101 +/- 1.5 to 85 +/- 2 mmHg (P less than .001). No changes in heart rate or postural hypotension were observed. During 1 yr of treatment, the antihypertensive efficacy of enalapril did not decline, and no clinical side effects were observed. Inhibition by enalapril of angiotensin-converting enzyme did not modify daily insulin requirements, glycemic control, uricemia, or lipid metabolism; kalemia and the markers of diabetic nephropathy were not significantly altered. These results suggest that enalapril once daily should be used as the first step in the treatment of diabetic patients with mild to moderate hypertension.

Beneficial Effects of Angiotensin-Converting Enzyme Inhibitor on Renal Function and Glucose Homeostasis in Diabetics with Hypertension

“…The present results show that the long-acting ACE inhibitor enalapril significantly lowered BP in diabetics with hypertension, which was consistent with previous reports [8]. Also, captopril has been shown to lower BP in type I and type II diabetic patients [9].…”

Comparison of the renal effects of angiotensin converting enzyme inhibitor and calcium antagonist in hypertensive Type 2 (non-insulin-dependent) diabetic patients with microalbuminuria: a randomised controlled trial

“…Hypertension is often associated with diabetic nephropathy [2], and effective antihypertensive treatment has proven to be effective in slowing the progression rate of nephropathy [3][4][5]. Recent studies in patients with diabetic nephropathy suggest that the use of angiotensin converting enzyme (ACE) inhibitors may possess specific advantages in decreasing proteinuria and slowing progression of nephropathy [6][7][8][9]. Nevertheless, whether such renal effects can be seen only with ACE inhibitors or whether ACE inhibitors have more beneficial renal effects as compared to other conventional antihypertensive drugs is uncertain.…”

Diabetes mellitus, the Renin-Angiotensin System, and Angiotensin-Converting Enzyme Inhibition

“…On the other hand, Marre et al [81] found that long-term enalapril treatment resulted in both an increase in GFR and a reduction in proteinuria in incipient diabetic nephropa thy. However, antihypertensive treatment with other drugs that lower BP to within the normotensive range can also reduce microalbuminuria [104], In other studies [105][106][107], ACE inhibition had no adverse effects on GFR in the presence of significant reductions in BP (table 1). Renal plasma How has been reported as unchanged or increased (table I) [3,81,105,106].…”