Perindopril for long term kidney protection

[Susiebabs]

Despite having excellent BP my doctor has now prescribed 2 mg of Perindopril every morning. He said that this was to protect my kidneys in the long-term, say 20 years down the line. This was the result of one of my kidney measures being slightly high but not out of the normal range.

I have been working very hard this year with a view to trying to come off all of the 10 tablets that I am currently taking. A small surgery on Tuesday has removed three of them and my blood sugar is now so good on a consistent basis (after going on to the LCHF lifestyle) that I am hoping to start weaning off all of my diabetic meds (4 x metformin and 1 x sitagliptin/januvia) after my next set of tests in a month's time.

The one tablet that I'm just unsure about is the Perindopril. I have not found anyone else who's been prescribed it for their kidneys rather than high blood pressure, in fact the consultants and others in the hospital assumed that I had hypertension because I was on the medication and it's their very bemusement that has led me to question whether or not I should be on this tablet at all.

Has anyone else been prescribed perindopril for their kidneys long-term protection and if so have you found it to be of benefit?




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[noblehead]

Ace inhibitor (those ending in pril) are often given to diabetic patients to prevent kidney disease, obviously the lower the bp the less strain it has on organs such as the kidneys and heart, I take a 5mg dose of ramipril and have done for several years after developing diabetic retinopathy, to date I've suffered no side-effects and don't see the harm in continuing to take it, every little helps as Tesco's would say

 

[Susiebabs]

Thanks for the reply. I think my main issue is that my blood pressure is very good normally around 110/60 therefore I can't see any benefit in taking a tablet whose primary function is to reduce your blood pressure.

Indeed I'm not sure that I'd want my blood pressure reduced any further. Think I'll put a note in to have a more in depth chat with the GP about it. He does seem quite quick with the meds as a problem solver (often wants to prescribe on a preventative rather than treatment basis and while I'm not adverse to the idea of preventative medicine I'd rather fully understand exactly what I'm putting into my body long-term).

I also really need to understand what results he was referring to and what sort of damage having those results in the 'high normal' range can do to you over a longer period of time. It wasn't very clear when I was talking to him and on reflection I should've taken notes at the time so I could go away research properly! Ah well you live and learn!


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[NoCrbs4Me]

Hi @Susiebabs - I just found this thread after my doctor prescribed perindopril for me this morning. She said it was to protect the kidneys from high blood sugar. Like you, I also have my blood sugar extremely well controlled with LCHF diet and my blood pressure is normal. I really don't want to be taking pills if I don't really need. Did you end up getting off these? What more info have you found out? Thanks!

 

[sarah]

I've been prescribed 2mg perindopril daily for the same reason. I don't personally have any problems with that. My aim is to keep healthy and well now and in the future, rather than be off all tablets.

 

[NoCrbs4Me]

Thanks @sarah. I like your answer. For me it's not so much a matter of being off all tablets. I take metformin even though my blood sugar levels are in the non-diabetc range through diet, exercise and weight loss. That's because I don't seem to be getting any side effects typical of it, like nausea, and other potential side effects are, according to the literature, not very common and metformin is supposed to decrease insulin resistance. However, all pills do have some side effects and the more different ones you take the more the chance of drug interaction. I guess my thought process is: if my blood sugar is under control and I don't have high blood pressure, do I really need to take a blood pressure lowering pill to protect my kidneys from high blood sugar? If I do, fair enough. But if I don't (i.e. it doesn't improve my health), then why take it? Hopefully I'll get an appointment with an endocrinologist soon and I will ask them that.

 

[sarah]

I do get your point, I hadn't really thought of it that way, and will be very interested in any answers you get from your endo. I think at GP level, we're all treated as if we will inevitably develop diabetes-related complications when some of us aren't willing to accept that that is the case.

 

[NoCrbs4Me]

The sad thing is that if you actually follow the official advice (eat lots of carbs and don't use a blood glucose monitor), you will eventually get diabetes related complications. Nevertheless, I can't find anything in any official or unofficial diabetic care guidelines that recommend an ACE inhibitor for diabetics that don't have hypertension or kidney disease, so I am questioning my GP's recommendation. I also read that ACE inhibitors can cause a persistent cough that doesn't always go away when you stop taking it.

I am definitely not against meds - I would actually like to increase my metformin dose because I don't think only 500 mg does anything for my blood glucose levels.

Anyway, I may not get the endo appointment for months, but I will try to post the outcome here.

 

[Andy_D85]

Any of the ACE Inhibitors as mentioned are primarily designed to reduce BP as mentioned...they have the secondary function of reducing potential damage to kidneys through diabetic complications. You're not however being prescribed them for their primary purpose - reducing your BP even from a healthy amount, will reduce natural strain on your kidneys, so if yours have shown ANY sign of performing outwith normal parameters, whether that's the upper range of 'normal' or full blown failure, then surely you would want to do anything and everything possible to avoid serious complications from happening? You seem to take very good care of yourself in general, so I personally can't understand the reluctance to be on a medication that you've been prescribed to protect your kidneys, especially when you've been informed the results of a standard test showed some results worth protecting?

I'm now approaching stage 5 Kidney Failure - after years of not testing/bolusing correctly, and ignoring advice to take varying different pills like this it's now too late for me to stop what's coming. Mine have been prescribed by a Nephrologist, not a GP or a Diabetic specialist, but a doctor who has spent his entire career focusing on the treatment of kidneys and all their diseases/conditions. As much as I do not like the doctor personally (he's a smarmy git at the best of times) I trust his medical knowledge.

Take it from someone who is at the very far end of one of the potential paths you can travel here, if they're advising you to take it NOW to prevent something bad from happening, then take the pill and be very grateful they were concerned enough to prescribe it, rather than waiting for something very bad to happen on the off chance you don't need it =)

Also I did a quick google before posting this and was returned with over 80,000 pages of reasoning and evidence to pour through showing the benefits of using either ACE or ARB Inhibitors to reduce/slow Diabetic related Chronic Kidney Disease - so your statement regarding there being no advice out there regarding the use of these types of medication to treat/slow Kidney Disease due to Diabetes seems a bit premature, there's definitely evidence out there, and it should definitely be followed in my opinion...I *KNOW* for certainty what happens when you don't =/.

 

[NoCrbs4Me]

Thanks for responding. I'm sorry to hear about your kidney issues.

My specific question was do I really need to take this med if my blood pressure and blood glucose levels are in the normal range. I already knew that it's a good thing to take if you have elevated blood glucose. I just couldn't find anything with respect to the aforementioned question.

All meds have side effects, so I don't think it's a good idea to take meds that you don't need to take. I was not ignoring the advice to take the ACE inhibitor, just questioning it. I take my doctors' advice seriously, but refuse to follow anything they say blindly any more. After all, it's my health, not theirs. If they screw up, they don't have any consequences, but I do.

Anyway, I met with a diabetes specialist a couple of weeks ago and he said I am no longer diabetic and don't need any meds. He seemed to know what he was talking about.

 

[Andy_D85]

Good news on your part that's awesome!

To clarify though, you'd have been prescribed the ACE not because of your glucose/HBA1c or BP...but because of any out of normal range kidney results? Even if I currently had a perfect HBA1c and BP (which is far from the case) I'd still be prescribed the ACE Inhibitors to try and prolong what little life my kidneys have - I possibly should have been clearer with that point in my first post =)

However looking back over the posts I now realise I'd mixed up a post by the OP and yourself so it's possible you had no out of range kidney results yourself - I'm unsure as it doesn't appear to be mentioned...

...Susiebabs on the other hand definitely needs to be taking these if she's still paying attention to the thread as it was her post I noticed that quote from! lol!

Once again, brilliant news on your side - and thanks for the well wishes =)

 

[NoCrbs4Me]

Kidney function tests were normal. I think my doctor just prescribed them as a normal procedure for type 2 diabetics. To her credit, when I asked her if I need them when my BP and BG were normal, she said she'd get me a referral to a specialist. to answer that question.

However, I think the OP was in a similar position as me since her kidney tests were normal as well. I can't imagine being on 10 different meds!