**Question:** Antihypeensive which can be used in patients with gout and diabetic mellitus is

A. Amlodipine
B. Enalapril
C. Losartan
D. Lisinopril

**Correct Answer:** Amlodipine

**Core Concept:**

Multiple-system involvement is common in patients with both gout and diabetes mellitus. These patients often require antihypertensive therapy to manage their high blood pressure. In such cases, a drug that is effective, safe, and well-tolerated is essential.

**Why the Correct Answer is Right:**

Amlodipine (Option A) is a calcium channel blocker (CCB) belonging to the dihydropyridine group. CCBs work by inhibiting the calcium channels in vascular smooth muscle cells, which results in vasodilation, decreased vascular resistance, and reduced blood pressure. Amlodipine has a low risk of causing orthostatic hypotension and is well-tolerated in patients with gout and diabetes mellitus.

**Why Each Wrong Option is Incorrect:**

B. Enalapril (Option B) is an angiotensin-converting enzyme (ACE) inhibitor. While effective in lowering blood pressure, ACE inhibitors are associated with a higher risk of worsening renal function in diabetic patients due to increased angiotensin II production and salt and water retention.

C. Losartan (Option C) is a selective angiotensin II receptor blocker (ARB). Similar to ACE inhibitors, ARBs can cause worsening of renal function in diabetic patients due to increased angiotensin II production and salt and water retention.

D. Lisinopril (Option D) is another ACE inhibitor. As mentioned earlier, ACE inhibitors can cause worsening renal function in diabetic patients due to increased angiotensin II production and salt and water retention.

**Clinical Pearl:**

In patients with gout and diabetes mellitus, it is crucial to choose an antihypertensive drug with a low risk of renal impairment. Amlodipine is the correct choice among the options provided due to its low risk of causing worsening renal function, making it suitable for managing hypertension in individuals with gout and diabetes.