<prompt> First drug of choice in a patient with Diabetes mellitus and concomitant hypertension?Calcium channel blockersa-adrenergicsb-adrenergicsACE inhibitors  <response>: Ans. d. ACE inhibitors Ref. Harrisons Internal medicine 17th edition, p. 1558; 16th edition, p. 1479Antihypertensive therapy:Primary essential hypertensionDiuretics, ACE inhibitors, angiotensin li receptor blockers ARBs, calcium channel blockers.Hypertension with CHFDiuretics, ACE inhibitorsARBs, b-blockers compensated CHF, aldosterone antagonists, p-blockers must be used cautiously in decompensated CHF and are contraindicated in cardiogenic shock.Hypertension with diabetes mellitusACE inhibitorsARBs. Calcium channel blockers, diuretics, b-blockers, a-blockers.ACE inhibitorsARBs are protective against diabetic nephropathy.ACE INHIBITORS AND DM No adverse effect on glucose and lipid metabolism No depression sexual dysfunction Lower intraglomerular pressure retards diabetic nephropathy by 50ACE INHIBITORSMECHANISMCLINICAL USETOXICITYCaptopril, enalapril, lisinopril.loss of feedback inhibition.Inhibition of ACE also prevents inactivation of bradykinin, a potent vasodilator.Hypertension, CHF, proteinuria, diabetic nephropathy. Prevent unfavorable heart remodeling as a result of chronic hypertension.Cough, Angioedema contraindicated in Cl esterase inhibitor deficiency, Teratogen fetal renal malformations, Creatinine GFR,Hyperkalemia, and Hypotension. Avoid in bilateral renal artery stenosis, because ACE inhibitors will further GFR -renal failure. Also remember: 