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Diabetes And Ace Inhibitors

Using Ace Inhibitors Appropriately

Using Ace Inhibitors Appropriately

When first introduced in 1981, angiotensin-converting enzyme (ACE) inhibitors were indicated only for treatment of refractory hypertension. Since then, they have been shown to reduce morbidity or mortality in congestive heart failure, myocardial infarction, diabetes mellitus, chronic renal insufficiency, and atherosclerotic cardiovascular disease. Pathologies underlying these conditions are, in part, attributable to the renin-angiotensin-aldosterone system. Angiotensin II contributes to endothelial dysfunction, altered renal hemodynamics, and vascular and cardiac hypertrophy. ACE inhibitors attenuate these effects. Clinical outcomes of ACE inhibition include decreases in myocardial infarction (fatal and non-fatal), reinfarction, angina, stroke, end-stage renal disease, and morbidity and mortality associated with heart failure. ACE inhibitors are generally well tolerated and have few contraindications. Cardiovascular disease affects one in four Americans. According to the American Heart Association, heart and related diseases are expected to cost Americans more than $329 billion in 2002. An estimated 10 million persons in this country are known to have diabetes and 3.6 million to have renal disease, incurring annual health care costs of $98 billion and $11 billion, respectively. Although angiotensin-converting enzyme (ACE) inhibitors have documented clinical benefits in a variety of clinical situations, the disparity between the evidence from clinical trials and bedside medicine is well documented. The National Registry of Myocardial Infarction 2 found that fewer than one half of patients surviving acute myocardial infarction who were candidates for therapy with ACE inhibitors received these life-saving drugs at discharge.1 A recent review of patients with asymptomatic l Continue reading >>

Ace Inhibitors Top Choice For Hypertension In Diabetes

Ace Inhibitors Top Choice For Hypertension In Diabetes

ACE Inhibitors Top Choice for Hypertension in Diabetes As recommended in guidelines, angiotensin-converting enzyme (ACE) inhibitors should be the first-line treatment in patients with hypertension who have diabetes mellitus (DM) when cost is not a concern, according to a new study. In addition, the authors suggest that calcium channel blockers might be the preferred treatment in combination with ACE inhibitors if adequate blood pressure control cannot be achieved by ACE inhibitors alone. Among patients with DM, ACE inhibitors fared better than placebo in reducing creatinine doubling, and beta-blockers were associated with an increased risk of death. In addition, ACE inhibitors in combination with other antihypertension medications did not show significant protective effects compared with placebo, but the likelihood of lowering mortality in patients was greater. Guidelines suggest ACE inhibitors or angiotensin receptor blockers (ARBs) should be the first-line treatment in in patients with hypertension who have DM when cost is not a concern. Clinical trials comparing an ACE inhibitor with an ARB are rare, and the difference in protective effects between these drugs for patients with DM remains inconclusive. No consensus exists about the choice of treatments in combination with renin-angiotensin system blockers in patients with DM, state lead author Hon-Yen Wu and colleagues from National Taiwan University Hospital and College of Medicine, Taipei, Taiwan. By combining direct and indirect evidence, our analyses show the renoprotective effects and superiority of ACE inhibitors in patients with diabetes, and also show the harmful effects of beta-blockers, the authors state. As the available evidence is not able to show a better protective effect for ARBs compared with ACE in Continue reading >>

Use Of Ace Inhibitors Linked To 24% Drop In Type 2 Diabetes Risk

Use Of Ace Inhibitors Linked To 24% Drop In Type 2 Diabetes Risk

Use of ACE Inhibitors Linked to 24% Drop in Type 2 Diabetes Risk Hamilton, OntarioWhich antihypertensive is prescribed makes a difference in the risk of developing type 2 diabetes (T2D), according to a new study, which suggests that this concept should be incorporated into clinical guidelines. A presentation at this years Annual Meeting of the European Association for the Study of Diabetes (EASD) in Barcelona, Spain, reports that using angiotensin-converting enzyme (ACE) inhibitors with lower blood pressure is linked to a 24% reduced risk of developing T2D compared with placebo. McMaster Universityled researchers also determined that natural genetic variations associated with ACE concentrations in the body are also related to T2D risk. Three large randomized control trialsHOPE, PEACE, SOLVDsuggested that ACE inhibitors might prevent T2D compared with placebo in people at high risk for cardiovascular outcomes, according to the report. Noting that the causal relation between ACE inhibition and prevention of the disease remains questionable, the authors posited that ACE concentration-lowering genetic variants could be used to infer the pharmacological effect of ACE inhibitors on T2D risk. To do that, researchers used a Mendelian Randomization approach, i.e., assessing individual risk of developing T2D based on natural genetic variations that influence the concentration of the ACE enzyme in the blood, and used this to infer the causal effects that ACE inhibitors would have on T2D risk. As a first step, the study team assessed the association between T2D prevalence and ACE serum concentration in the Outcome Reduction with Initial Glargine Intervention (ORIGIN) trial, which had more than 8,000 participants. Then, researchers investigated whether 17 genetic variants linked to Continue reading >>

Renoprotective Effect Of Angiotensin-converting Enzyme Inhibitors And Angiotensin Ii Receptor Blockers In Diabetic Patients With Proteinuria

Renoprotective Effect Of Angiotensin-converting Enzyme Inhibitors And Angiotensin Ii Receptor Blockers In Diabetic Patients With Proteinuria

Abstract Background/Aims: Limited evidence exists on the choice of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in diabetic patients with nephropathy. We aim to assess the renal effectiveness and safety of these drugs among diabetic nephropathy patients. Methods: This retrospective cohort study was conducted with diabetic nephropathy patients who initiated ACEI or ARB monotherapy. The primary outcome was a composite of end stage of renal disease and renal transplantation, and the secondary outcome was all-cause mortality. The safety endpoint was hyperkalemia. Results: Three thousand seven hundred and thirty-nine ACEI users and 3,316 ARB users were identified. ARBs seemed to be inferior to ACEIs given their poorer renal outcome (HR 1.31; 95% CI, 1.15-1.50) and higher risk of hyperkalemia (HR 1.17; 95% CI, 1.04-1.32). Among the four ACEIs compared, captopril was an inferior treatment choice given its poorer renal outcomes (HR 1.42; 95% CI, 1.05-1.93) and higher mortality rate (HR 1.25; 95% CI, 1.01-1.55). Irbesartan appeared to be a poorer treatment choice among the three ARBs compared, given its inferior renal protective effect (HR 1.35; 95% CI, 1.03-1.78). Conclusions: Our findings suggest ACEIs as a relatively more renoprotective and safer treatment as compared to ARBs. Captopril and irbesartan may be inferior to the other ACEIs and ARBs respectively. © 2017 The Author(s). Published by S. Karger AG, Basel Introduction Diabetic nephropathy is a common complication among patients with diabetes mellitus (DM) and the leading cause of chronic kidney disease (CKD) in developed countries [1]. It involves an increase in proteinuria and decrease in glomerular filtration rate. The continuous kidney damage can lead to irreversible Continue reading >>

Learning About Ace Inhibitors And Arbs For Diabetes

Learning About Ace Inhibitors And Arbs For Diabetes

Learning About ACE Inhibitors and ARBs for Diabetes ACE inhibitors and ARBs are medicines used to control blood pressure. They allow blood vessels to relax and open up. This lowers your blood pressure. When you have diabetes, taking an ACE inhibitor or ARB can help to: Treat high blood pressure. Your risk of problems from diabetes goes up when you have high blood pressure. Prevent or slow kidney damage. Diabetes can damage the blood vessels in the kidneys. High blood pressure can damage the kidneys, too. Lower the risks of stroke and heart attack. Your risks go up when you have high blood pressure, heart disease, or both. An ACE inhibitor or ARB is a good choice for people with diabetes. Unlike some medicines, these don't affect blood sugar levels. Some side effects of ACE inhibitors include: Low blood pressure. You may feel dizzy and weak. An allergic reaction of the skin. Symptoms may range from mild swelling to painful welts. You may have other side effects or reactions not listed here. Check the information that comes with your medicine. Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor or nurse call line if you think you are having a problem with your medicine. Before starting an ACE inhibitor or ARB, tell your doctor if you: These medicines are not safe for pregnancy. If you are pregnant or planning to be, talk to your doctor about a safe blood pressure medicine. ACE inhibitors can cause a dry cough. If the cough is bad, talk to your doctor. Switching to an ARB is likely to help. Taking some medicines together can cause problems. Tell your doctor or pharmacist all the medicines you take. This includes over-the-counter medicines and natural health products. You may need regular blood and urine tests. Go to Enter M316 in the search Continue reading >>

Role Of Ace Inhibitors In Patients With Diabetes Mellitus.

Role Of Ace Inhibitors In Patients With Diabetes Mellitus.

Abstract The adjective 'epidemic' is now attributed to the rapidly growing number of patients with diabetes mellitus, mainly type 2. and the specific complications linked to this disorder. Provided they are recognised early enough, these different complications can be treated; in some patients the evolutive course of these complications can be slowed or even stopped. Furthermore, some recent observations suggest that specific tissular lesions may be prevented or even reversed. Although glycaemic control is essential, other therapeutic measures that must also be taken include those to control blood pressure and to lower lipid levels. Of the agents available to control the complications of diabetes mellitus, cardiovascular drugs, and particularly ACE inhibitors, have a pre-eminent place. Experimental and epidemiological data suggest that activation of the renin-angiotensin-aldosterone system plays an important role in increasing in the micro- and macrovascular complications in patients with diabetes mellitus. Not only are ACE inhibitors potent antihypertensive agents but there is a growing body of data indicating that also they have a specific 'organ-protective' effect. For the same degree of blood pressure control, compared with other antihypertensive agents, ACE inhibitors demonstrate function and tissue protection of considered organs. ACE inhibitors have been reported to improve kidney, heart, and to a lesser extent, eye and peripheral nerve function of patients with diabetes mellitus. These favourable effects are the result of inhibition of both haemodynamic and tissular effects of angiotensin II. Finally, there are a growing number of arguments favouring the use of ACE inhibitors very early in patients with diabetes mellitus. Continue reading >>

The Use Of Ace Inhibitors

The Use Of Ace Inhibitors

The Kidneys and Diabetes Back to Related Health Issues ACE inhibitors, are drugs normally used for the treatment of high blood pressure. This is a category of drugs called Angio-Converting Enzyme inhibitors – ACE for short. ACE is an enzyme found in our bodies which activates a hormone called angiotensin causing the blood vessels to constrict, so raising blood pressure and putting pressure on the heart. ACE inhibitors prevent the action of angiotensin resulting in a lowering of blood pressure. However, there is evidence that the use of ACE inhibitors in people who start to show small amounts of protein in the urine, helps to reduce the progression to macroalbuminuria. In other words the use of ACE inhibitors has a protective effect on the kidneys, even in people whose blood pressure is normal. What does the research show? A meta-analysis [Ann Intern Med 2001 March ; 134[5] 370-9] was published on this subject. This is an analysis of studies to provide better evidence than just looking at individual studies. In this case, the studies were selected on the following basis: They included at least 10 people with Type 1 diabetes who had microalbuminuria and normal blood pressure. They had a control group who were not treated with ACE inhibitors [placebo group] They had follow up results at least a year later. 12 studies were selected with a total of 698 patients. The results showed: The progression to macroalbuminuria was reduced in patients receiving ACE inhibitors. After two years the albumin excretion rate was 50.5% lower in treated patients than in those receiving a placebo [no treatment]. For patients with normal blood pressure, Type 1 diabetes and microabluminuria, ACE inhibitors significantly reduced progression to macroalbuminuria and also increased the chances of r Continue reading >>

Jmcp

Jmcp

Accepted Manuscript - Manuscripts that have been selected for publication. They have not been typeset and the text may change before final publication. Uncorrected Proof - Articles that are not yet finalized and that will be corrected by the author(s). The text could change before final publication. (Uncorrected proofs may be temporarily unavailable for production reasons) Corrected Proof - Articles containing author corrections will usually remain unchanged and possible further corrections are fairly minor. Typically the only difference with the final published article is that specific issue and page numbers have not yet been assigned. Although these articles do not have all bibliographic details available yet, they can be cited using the year of online publication and the DOI as follows: Author(s), Article title, Publication (year), DOI. Please consult the journal's reference style for the exact appearance of these elements, abbreviation of journal names, and use of punctuation. Continue reading >>

Ace Inhibitors (side Effects, List Of Names, Uses, And Dosage)

Ace Inhibitors (side Effects, List Of Names, Uses, And Dosage)

What are ACE inhibitors, and how do they work (mechanism of action)? Angiotensin II is a very potent chemical produced by the body that primarily circulates in the blood. It causes the muscles surrounding blood vessels to contract, thereby narrowing the vessels. The narrowing of the vessels increases the pressure within the vessels causing increases in blood pressure (hypertension). Angiotensin II is formed from angiotensin I in the blood by the enzyme angiotensin converting enzyme (ACE). (Angiotensin I in the blood is itself formed from angiotensinogen, a protein produced by the liver and released into the blood.) Angiotensin converting enzyme inhibitors (ACE inhibitors) are medications that slow (inhibit) the activity of the enzyme ACE, which decreases the production of angiotensin II. As a result, blood vessels enlarge or dilate, and blood pressure is reduced. This lower blood pressure makes it easier for the heart to pump blood and can improve the function of a failing heart. In addition, the progression of kidney disease due to high blood pressure or diabetes is slowed. Why are ACE inhibitors prescribed (uses)? ACE inhibitors are used for: ACE inhibitors also improve survival after heart attacks. In studies, individuals with hypertension, heart failure, or prior heart attacks who were treated with an ACE inhibitor lived longer than patients who did not take an ACE inhibitor. ACE inhibitors are an important group of drugs because they prevent early death resulting from hypertension, heart failure or heart attacks. Some individuals with hypertension do not respond sufficiently to ACE inhibitors alone. In these cases, other drugs often are used in combination with ACE inhibitors. List of examples of brand and generic drug names for ACE inhibitors The following is a li Continue reading >>

Ace Inhibitors Improve Diabetic Nephropathy Through Suppression Of Renal Mcp-1

Ace Inhibitors Improve Diabetic Nephropathy Through Suppression Of Renal Mcp-1

OBJECTIVE—Chemokines play an important role in the pathogenesis of diabetic nephropathy. Angiotensin II induces several fibrogenic chemokines, namely monocyte chemoattractant protein-1 (MCP-1) and transforming growth factor-β. The progression of diabetic nephropathy can be retarded by ACE inhibitors (ACEIs) in patients with type 1 and type 2 diabetes. We examined if blockade of the renin-angiotensin system lowered urinary levels of the chemokine MCP-1 and correlated urinary MCP-1 (uMCP-1) with parameters of renal function and glucose and lipid metabolism before and after 1 year of treatment with an ACE inhibitor. RESEARCH DESIGN AND METHODS—In 22 patients with type 2 diabetes and diabetic nephropathy in stages 3–5, treatment with the ACEI lisinopril was initiated. Before treatment and after 12 months of continuous therapy, proteinuria, creatinine clearance, uMCP-1 levels, BMI, HbA1c, and serum cholesterol were assessed. RESULTS—Lisinopril treatment improved renal function. Proteinuria decreased from 410 ± 662 mg per 24 h to 270 ± 389 mg per 24 h. Creatinine clearance rose from 61 ± 26 to 77 ± 41 ml/min. Urinary MCP-1 levels decreased from 0.456 ± 0.22 ng/mg creatinine to 0.08 ± 0.096 ng/mg creatinine. The change in uMCP-1 correlated significantly (r = 0.61, P < 0.001) with the change in proteinuria. No other parameter correlated with the improvement in renal function. CONCLUSIONS—Blockade of the renin-angiotensin system in type 2 diabetic patients with diabetic nephropathy reduces uMCP-1 levels and improves renal function. Because MCP-1 induces monocyte immigration and differentiation to macrophages, which augment extracellular matrix production and tubulointerstitial fibrosis, pharmacological reduction of angiotensin II may also exert its beneficial ef Continue reading >>

Should All Patients With Type 1 Diabetes Mellitus And Microalbuminuria Receive Angiotensin-converting Enzyme Inhibitors?: A Meta-analysis Of Individual Patient Data

Should All Patients With Type 1 Diabetes Mellitus And Microalbuminuria Receive Angiotensin-converting Enzyme Inhibitors?: A Meta-analysis Of Individual Patient Data

Purpose: To determine whether response of albumin excretion rate to angiotensin-converting enzyme (ACE) inhibitors has a threshold in patients with type 1 diabetes mellitus and microalbuminuria and to examine treatment effect according to covariates. Study Selection: Selected studies included at least 10 normotensive patients with type 1 diabetes mellitus and microalbuminuria, had a placebo or nonintervention group, and included at least 1 year of follow-up. Data Extraction: Raw data were obtained for 698 patients from the 12 identified trials. Analysis of treatment effect at 2 years was restricted to trials with at least 2 years of follow-up (646 patients from 10 trials). Data Synthesis: In patients receiving ACE inhibitors, progression to macroalbuminuria was reduced (odds ratio, 0.38 [95% CI, 0.25 to 0.57]) and the odds ratio for regression to normoalbuminuria was 3.07 (CI, 2.15 to 4.44). At 2 years, albumin excretion rate was 50.5% (CI, 29.2% to 65.5%) lower in treated patients than in those receiving placebo (P�<�0.001). Estimated treatment effect varied by baseline albumin excretion rate (74.1% and 17.8% in patients with a rate of 200 µg/min and 20 µg/min, respectively [P�=�0.04]) but not by patient subgroup. Adjustment for change in blood pressure attenuated the treatment difference in albumin excretion rate at 2 years to 45.1% (CI, 18.6% to 63.1%; P�<�0.001). Conclusions: In normotensive patients with type 1 diabetes mellitus and microalbuminuria, ACE inhibitors significantly reduced progression to macroalbuminuria and increased chances of regression. Beneficial effects were weaker at the lowest levels of microalbuminuria but did not differ according to other baseline risk factors. Changes in blood pressure cannot entirely explain Continue reading >>

Ace Inhibitors Or Arbs To Prevent Ckd In Patients With Microalbuminuria

Ace Inhibitors Or Arbs To Prevent Ckd In Patients With Microalbuminuria

ACE Inhibitors or ARBs to Prevent CKD in Patients with Microalbuminuria JASON M. CORBO, PharmD, BCPS, South Texas Veterans Health Care System, San Antonio, Texas TERESA M. DELELLIS, PharmD, BCPS, Manchester University College of Pharmacy, Natural, and Health Sciences, Fort Wayne, Indiana LUCAS G. HILL, PharmD, BCPS, BCACP, The University of Texas at Austin College of Pharmacy, Austin, Texas SARAH L. RINDFUSS, PharmD, BCPS, Allegheny Health Network, West Penn Hospital Care Partner Clinic, Pittsburgh, Pennsylvania JOAN NASHELSKY, MLS, University of Iowa Center for Human Rights, Iowa City, Iowa Am Fam Physician.2016Oct15;94(8):652-653. Does therapy with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) prevent progression to chronic kidney disease (CKD) in normotensive patients with microalbuminuria? ACE inhibitors reduce the risk of progression to macroalbuminuria in normotensive patients with microalbuminuria and type 1 diabetes mellitus. (Strength of Recommendation [SOR]: C, based on a meta-analysis of randomized controlled trials [RCTs] with disease-oriented outcomes.) ACE inhibitors and ARBs reduce the risk of progression to macroalbuminuria in normotensive patients with microalbuminuria and type 2 diabetes. (SOR: C, based on disease-oriented evidence from small RCTs.) ACE inhibitors and ARBs do not reliably affect serum creatinine levels. Recommendations are not available for normotensive patients without diabetes who have microalbuminuria. A 2001 meta-analysis of 10 small RCTs (N = 698) described the effect of ACE inhibitors vs. placebo on progression to macro-albuminuria in normotensive patients with microalbuminuria and type 1 diabetes. 1 Several definitions of normotension were allowed; microalbuminuria was defined as a urina Continue reading >>

Type 2 Diabetes Mellitus With Angiotensin-converting-enzyme Inhibitors

Type 2 Diabetes Mellitus With Angiotensin-converting-enzyme Inhibitors

Currently, ACE inhibitors and angiotensin II-receptor blockers are recommended to prevent cardiovascular disease and nephropathy in patients with type 2 diabetes.[ 3 , 7 , 26 ] Clinical data from randomized controlled trials have validated the physiological effects of angiotensin II on the pancreas. Though none of the trials involving ACE inhibitors used new-onset diabetes as a primary endpoint and each trial had its own limitations, the reproducibility of the results is encouraging. The Captopril Prevention Project (CAPPP) was a prospective, randomized, open-label trial with a blinded endpoint evaluation.[ 27 ] The objective of this study was to compare cardiovascular morbidity and mortality in hypertensive patients using an ACE inhibitor or conventional antihypertensive treatment, which included diuretics (most commonly hydrochlorothiazide and bendrofluazide) and -blockers (most commonly atenolol and metoprolol). A total of 10,985 patients age 25-66 years with a diastolic blood pressure of 100 mm Hg on two occasions were enrolled and randomly assigned to receive either captopril (50-200 mg daily) or conventional antihypertensive treatment for 6.1 years. New-onset diabetes mellitus, defined per 1985 World Health Organization criteria,[ 28 ] was set as a secondary outcome for this study. At baseline, diabetes was more prevalent in the captopril group (5.6%) than the conventional therapy group (4.8%). However, by the studys end, the prevalence of diabetes mellitus in the captopril-treated group was significantly less than that in the conventional treatment group (RR, 0.86; 95% CI, 0.74-0.99; p = 0.039). Two major concerns noted about the trial were the randomization method and the control medications used. Patients were randomized using a computer-generated number seque Continue reading >>

Ace Inhibitors

Ace Inhibitors

A class of medicine usually used to treat high blood pressure. Angiotensin-converting enzyme (ACE) inhibitors also appear to protect people with diabetes from diabetic nephropathy (kidney disease). People with diabetes are especially prone to hypertension (defined as a blood pressure level of 140/90 mm Hg or greater). Some 20% to 60% of individuals with diabetes have high blood pressure. Hypertension increases their risk not only of heart disease and stroke, but also of peripheral vascular disease, diabetic retinopathy, diabetic nephropathy, and possibly diabetic neuropathy. The American Diabetes Association (ADA) currently recommends a target blood pressure level of under 130/80 mm Hg in people with diabetes. The ADA recommends a number of different measures for lowering blood pressure, including weight loss, sodium restriction, and exercise. When these measures aren’t enough, the addition of one or more medicines is warranted. There are several different classes of blood pressure drugs, including angiotensin-receptor blockers (ARBs), diuretics, beta blockers, and ACE inhibitors. Overall, drug therapy has been shown to substantially decrease the risk of cardiovascular disease, diabetic retinopathy, and diabetic nephropathy. ACE inhibitors may have a special advantage in terms of slowing the progression of diabetic nephropathy. Research findings show that ACE inhibitors can slow the progression of kidney disease to a greater degree than other antihypertensive drugs that lower blood pressure by a similar amount and that they may be able to protect the kidneys even in people with diabetes whose blood pressure levels are in the normal range. This suggests that ACE inhibitors protect the kidneys by mechanisms other than just blood pressure control. Currently, the ADA reco Continue reading >>

Angiotensin-converting Enzyme (ace) Inhibitors

Angiotensin-converting Enzyme (ace) Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors Angiotensin-converting enzyme (ACE) inhibitors ACE inhibitors treat a variety of conditions, such as high blood pressure, scleroderma and migraines. Find out more about this class of medication. Angiotensin-converting enzyme (ACE) inhibitors help relax blood vessels. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance in your body that narrows your blood vessels and releases hormones that can raise your blood pressure. This narrowing can cause high blood pressure and force your heart to work harder. Many ACE inhibitors are available. Which one is best for you depends on your health and the condition being treated. People with chronic kidney disease may benefit from having an ACE inhibitor as one of their medications. People of African heritage and older people respond less well to ACE inhibitors than do white and younger people. In rare cases but more commonly in people of African heritage and in smokers ACE inhibitors can cause some areas of your tissues to swell (angioedema). If it occurs in the throat, the swelling can be life-threatening. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), decrease the effectiveness of ACE inhibitors. Taking an occasional dose of these medications shouldn't change the effectiveness of your ACE inhibitor, but talk to your doctor if you regularly take NSAIDs. Because ACE inhibitors can cause birth defects, talk to your doctor about other options to treat your blood pressure if you're pregnant or you plan to become pregnant. Continue reading >>

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