ACE inhibitors are frequently an excellent choice for the treatment of hypertension, particularly in patients with diabetes. Magnesium is also beneficial because it reduces insulin resistance and protects against arrhythmias. But does the ACE inhibitor decrease magnesium excretion as it does potassium excretion? Can an ACE inhibitor and magnesium be used together safely?
—Richard Levin, MD, Van Nuys, Calif.
ACE inhibitors certainly should be considered one of the mainstays of antihypertensive therapy, particularly in diabetic patients. However, the routine use of magnesium supplementation to “reduce insulin resistance” and for its anti-arrhythmic properties is somewhat more controversial. Hypomagnesemia has recently been associated with the metabolic syndrome, and the American Diabetes Association recommends that diabetics with low magnesium levels receive supplementation. Beyond this, data for use in patients with hypertension and chronic arrhythmia are inconclusive. Renal magnesium handling relies mostly on glomerular filtration and passive re-absorption. And while many drugs can affect serum magnesium levels (loop diuretics, amphotericin), ACE inhibitors are not thought to be major culprits.
—Christopher Ruser, MD (114-6)