Role of angiotensin-converting enzyme inhibitors in early antihypertensive treatment in non-insulin dependent diabetes mellitus.

The effect of captopril monotherapy on blood pressure and metabolism was investigated in a placebo-controlled study in 30 non-insulin dependent (Type II) diabetic subjects during a 3-week observation period (run-in/drug; placebo/wash-out) on a metabolic ward. Captopril significantly reduced both systolic and diastolic blood pressure (154/90 +/- 5/2 vs. 144/86 +/- 4/3 mmHg) without major side effects. Mean run-in postprandial blood glucose concentrations were also reduced upon ACE-inhibition (9 a.m.: 12.7 +/- 0.4 vs. 11.1 +/- 0.4 mmol/l; 1 p.m.: 11.0 +/- 0.3 vs. 8.9 +/- 0.3 mmol/l; P less than 0.05), while blood kinin concentrations (40.0 +/- 2.5 pmol/l) were approximately doubled (108.8 +/- 23.5 pmol/l; P less than 0.05). Body mass index, fasting plasma insulin, serum electrolyte pattern, uric acid, white blood count, lipid profile as well as hepatic and renal function parameters remained unaltered throughout the observation period. The data are in line with recent experimental studies showing a beneficial metabolic effect of captopril in Type II diabetes. ACE inhibitors might therefore become first-line drugs in early antihypertensive intervention in Type II diabetic patients.