ACE inhibitors (angiotensin-converting enzyme inhibitors) are used to treat high blood pressure. The drugs work by interfering with the formation of a hormone that can narrow blood vessels and increase blood pressure. Some examples of these medications include the drugs such as Accupril, Monopril, Vasotec, and Zestril.

While blood pressure control is important in diabetes, there's also evidence that these drugs protect the kidneys from damage -- another serious complication that results from uncontrolled diabetes, he explains. People with diabetes are at higher risk for heart disease and early death. But in his study of newly diagnosed people, he shows that these drugs can decrease the risk of death even in people without pre-existing heart disease.

A study reported in the June issue of Diabetes Care is the first to investigate -- in a large population -- the heart-health benefits of these drugs in people with diabetes.

His finding: ACE inhibitors cut the risk of death in half, he reports. Also, the drugs reduced the risk of death from heart disease by 23%. "ACE inhibitors reduce [death] risk, whether there is heart disease or not," says Johnson.

In his study, Johnson and his colleagues analyzed nearly five years worth of medical records of people with newly diagnosed diabetes -- almost 1,200 "new users" of ACE inhibitors and almost 5,000 people with type 2 diabetics not taking ACE inhibitors. The volunteers were men and women whose average age was 61 years old.

During the five-year study, researchers found significantly fewer deaths in the people with type 2 diabetes on ACE inhibitors:

• 9% of the ACE inhibitor group died, compared with 17% of those not taking the medication.
  
• Of those deaths, only 3% in the ACE inhibitor group were related to heart disease, compared with 5% in the comparison group.
  
• Previous research has demonstrated that ACE inhibitors improve cardiovascular and renal outcomes in a generalized cohort of patients with type 2 diabetes.
  
• Recent data show that ACE inhibitors reduce all-cause and cardiovascular mortality in newly treated patients with type 2 diabetes.

Diabetes Care. 2004;27:1330-1334

Donald G. Vidt, MD, consultant in the department of nephrology and hypertension for The Cleveland Clinic Foundation, offered his opinion of the findings.

Johnson's study helps back up what doctors have long suspected -- that ACE inhibitors have an effect independent of heart disease, Vidt explains. "It would appear that use of ACE inhibitors significantly reduces risk of early death. This is a big issue because we don't necessarily recommend starting ACE inhibitors in every [patient with type 2 diabetes]. But this study suggests we need to look again at this issue. There may be benefit to starting patients on these drugs very early."

Another class of high blood pressure medications, called angiotensin receptor blockers, can be substituted for people who can't tolerate ACE inhibitors, Vidt says. Examples of these drugs include Avapro, Cozaar, and Diovan.

Diabetes Care June 2004