Which of the following drugs is MOST suitable for a 45-year old diabetic with blood pressure 150/95 mmHg?
**Core Concept**
The patient in question has both diabetes and hypertension, requiring a medication that effectively controls blood pressure while also being safe for individuals with diabetes. This involves considering the effects of the medication on glucose metabolism and renal function.
**Why the Correct Answer is Right**
The correct answer, **C. Enalapril**, is an angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors are beneficial in patients with diabetes due to their ability to reduce the progression of diabetic nephropathy. They also have a neutral effect on glucose metabolism and do not worsen renal function in patients with diabetes. By blocking the conversion of angiotensin I to angiotensin II, enalapril reduces blood pressure and decreases the strain on the kidneys. This is particularly important in patients with diabetes who are at increased risk of developing kidney disease.
**Why Each Wrong Option is Incorrect**
**Option A:** Amlodipine is a calcium channel blocker that can increase the risk of edema and hypotension, particularly in patients with diabetes who are already at risk of peripheral neuropathy and nephropathy.
**Option B:** Metoprolol is a beta-blocker that can mask the symptoms of hypoglycemia, making it a less suitable choice for diabetic patients. Additionally, beta-blockers may worsen renal function in patients with diabetes.
**Option D:** Hydrochlorothiazide is a thiazide diuretic that can worsen glucose intolerance and increase the risk of hyperuricemia, making it a less ideal choice for diabetic patients.
**Clinical Pearl / High-Yield Fact**
ACE inhibitors like enalapril are often the preferred choice for patients with diabetes due to their renal protective effects and neutral impact on glucose metabolism.
**Correct Answer:** C. Enalapril