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About Blood Pressure Medications for Diabetic Kidney Disease

Protecting the kidneys is very important for patients with diabetes. Most patients who have diabetic kidney disease also have high blood pressure and higher amount of protein in urine and need medication to lower the blood pressure and reduce protein in the urine.

There are several classes of blood pressure pills, and usually several choices in each class. One target for some of the classes is the “renin-angiotensin system”.

This is a natural hormone system in the body that is too active in patients with diabetes.

At the center of the system is Angiotensin II, a hormone that makes blood vessels constrict. When small blood vessels are narrowed, it is harder for the heart to pump blood through them, so blood pressure rises. A second action of Angiotensin II is to cause chronic damage to the kidneys in diabetes.

ACE Inhibitors

It is no surprise then that blocking this system is important to protecting the kidneys. The most common way to block the system is by inhibiting the pathway through it. ACE inhibitors are used for this.

ACE inhibitors are medicines that were first designed to treat high blood pressure, and are now used to treat chronic kidney disease especially if there is too much protein in urine. ACE inhibitors are safe for most, but not all, people. They are not safe during pregnancy or if you have higher potassium, or if you have ever had a severe allergic reaction where your tongue and lips swelled. This may put you at risk for a similar reaction to other ACE inhibitor.

If you do have this kind of allergic reaction while taking the medicine, go to the emergency room promptly.


There is a related group of drugs called Angiotensin II Receptor Blockers (ARBs).

ARBs block the receptors in the system, rather than the formation of angiotensin through the pathway. ARBs are also useful for diabetic kidney disease, and are commonly used instead of ACE inhibitors, as an alternative to ACE inhibitors, or even with ACE inhibitors.

Results from three large clinical trials have shown that ARBs slow diabetic kidney disease in patients with type II diabetes who have higher protein in urine. ARBs are less likely to cause cough or other reactions, although they do lower the blood pressure and may make the creatinine and potassium tests go up and are not safe in pregnancy, either.

Both ACE inhibitors and ARB reduce the amount of protein and microalbumin in urine beyond their blood pressure benefits and slow the progression of diabetic kidney disease. Either one of ACEI or ARB medications are used if possible in patients with excessive protein or microalbumin in urine.

Both classes of drugs, the ACE inhibitors and ARBs, require monitoring by the physician when initially used, to check the blood pressure and laboratory tests.

Page last updated: November 07, 2019