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What is A diabetic patient with hypertension, which drug is preferred: and explain in detail?
Ans. (a) ACE InhibitorRef Harrison's 18th ed. Ch 344* In a diabetic patient, hypertension can accelerate compli- cations of DM, particularly cardiovascular disease and nephropathy. In these patients ACE inhibitor is preferred. It slows down the progression of diabetic nephropathy.* American Diabetic Association recommends that all patients with diabetes and hypertension be treated with an ACE inhibitor or an ARB.* Subsequently, agents that reduce cardiovascular risk (beta blockers, thiazide diuretics, and calcium channel blockers) should be incorporated into the regimen.* While ACE inhibitors and ARBs are likely equivalent in most patients with diabetes and renal disease, the ADA notes:# In patients with type 1 diabetes, hypertension, and micro- or macroalbuminuria, an ACE inhibitor slowed progression of nephropathy# An ACE inhibitor or an ARB slowed the progression to macroalbuminuria in patients with type 2 diabetes, hypertension, and microalbumin-uria; and# ARB slowed the decline in GFR in patients with type 2 diabetes, hypertension, macroalbuminuria, and renal insufficiency.