ACE Inhibitors and Type I diabetes


My blood pressure has been elevated every visit at the doctor's office. For a year they have ignored it. Last visit it was 160/93. I was given a prescription for Lisinopril/HCTZ combination med. HCTZ causes a rash so I will not be taking it. I also have Polycystic Kidney Disease (PKD). Despite confirmation of this by a CAT scan, the doctor keeps saying I don't because "cysts are normal". Mine are large hemorrhagic cysts, so in my opinion he is an idiot. I cannot change doctors due to no insurance and no physician here will accept a diabetic without insurance. My Hemoglobin A1C was 6.2 in June, and no lab was done on last visit (Sept 29). He only draws lab every 6 months if he thinks of it.
Diabetes diagnosed May 31, 2013.
Enough for the "history". What are the thoughts on ACE inhibitors? I have looked at the information regarding them, and I am very hesitant.

Thank you for any responses.


I have to tell you there is no substitute for seeing a doctor for medical advice. That being said I can tell you that medscape, which is a well respected and credible site has a specific article written and reviewed by doctors which says the following about PKD and ACE inhibitors:

The drugs of choice for hypertension are angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs).

The article has more detailed discussion of blood pressure problems in PKD, why they happen and why it is important to treat it.

Hope that is helpful. But still this is no substitute for seeing a nephrologist.

Most diabetics take some form of BP med, even when they do not have high BP. Taking a prophylactic med for kidney protection is common. Your High BP is doing much more damage
than the BP med,s. There are plenty to choose from, just find one you can live with.

Thank you for the Medscape link, interesting article.

My doc introduced me to them more than a decade ago, I did a little research, and I went with the ACE inhibitors whole-heartedly. I do not have any adverse effects to them. I've had T1 for a third of a century now, and I'm gonna take all the help I can get to get me another 50 years or so with as few complications as possible. I wish I had started on ACE inhibotors at diagnosis 33 years ago but I don't think the advantages were known back then.

Controlling my blood pressure is very important. Being diabetic (even fairly well controlled) is a big risk factor for retinopathy, kidney disease, etc. Adding on top of that high blood pressure, which is in itself a big risk factor for those same complications, makes it even more important to me.

Someone diagnosed late in life and not trying to go a century without complications, or with strong reactions to ACE/ARB inhibitors, could end up with a different conclusion that I would respect.

From my own personal experience, I believe that the addition of the one of the first ACEs (Captopril in the late 80s) kept my already damaged kidneys (from long term T1) going for quite some time. They were still new back then. The Capto was a pain as it was a 3 or 4X per day med. I took Vasotec for a bit, but it made me feel awful and then was on lisinopril for a long time. Keep in mind that my kidneys already had a good bit of damage, but I didn't go on dialysis until 2001 (almost 20 years later).

There are some side effects, but typically it's a cough and often changing to an ARB or another ACE works fine.

There is one significant side effect (sorry, forgotten, but I think it's worsening of kidney damage) but of all my years online (close to 20) I've only ever seen one person have it.

So like any drug, there are side effects, but the drug is quite effective. I'm sure your doc will order some labs at the beginning to check on you a bit.

Best of luck