ACE Inhibitors Improve Arterial Elasticity in Normotensive Diabetics

Treating diabetic patients with ACE inhibitors before they develop hypertension could prevent cardiovascular complications. Dr. Irene Gavras of the Boston University School of Medicine and colleagues reported that six months of treatment with perindopril improved arterial elasticity as measured by pulse wave velocity (PWV) in some normotensive patients with diabetes.
Significant reductions in PWV were seen among patients with type 1 diabetes, whose average age was about 41.5, but did not occur in patients in the study with type 2 diabetes, whose average age was 56.5.

Dr. Gavras stated that, "It looks as though when you are old you already have enough structural changes in your arteries that 6 months of an ACE inhibitor doesn’t make any difference. However, she added, it’s possible that treatment for a longer period of time might produce significant results in older patients.”

Studies have shown that normotensive diabetic patients may have increased arterial stiffness before hypertension or other cardiovascular complications have developed, Dr. Gavras and her colleagues note. Their study is the first to look at the effect of an ACE inhibitor in these patients.

Among the 42 patients in the study, PWV was 13.09 m/sec at baseline, compared to 9.5 m/sec for 15 controls without diabetes. After 6 months on perindopril, 4 mg/day, average PWV in the 16 patients with type 1 diabetes had fallen from 12.59 m/sec to 10.35 m/sec (p < .001). Among the 26 patients with type 2 diabetes, PWV had fallen from 13.37 m/sec to 12.42 m/sec, which was not a significant difference.

"The data suggest that early initiation of ACE inhibitor therapy in normotensive diabetics may be cardioprotective, just as it already has been shown to be nephroprotective before the onset of clinical signs of diabetic nephropathy," Dr. Gavras and her colleagues conclude.
Am J Hypertens 2005;18:18-22.

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FACT:
In October 2004, over 8,000 walkers participated in the three-mile "Walk to Cure Diabetes," raising approximately $1.2 million, the greatest amount ever raised by the Juvenile Diabetes Research Foundation (JDRF) Long Island Chapter. The annual "Walk to Cure Diabetes" is JDRF’s largest fund-raising event of the year and is one of the three biggest walks in the world.