In a patient with concomitant diabetes, anti hypeensive agent of choice is: September 2005
## Core Concept
The management of hypertension in patients with diabetes requires careful consideration of the antihypertensive agent's effects on glucose metabolism, kidney function, and cardiovascular risk. The ideal agent should not adversely affect glycemic control and should provide additional renal protection.
## Why the Correct Answer is Right
The correct answer, **Angiotensin-Converting Enzyme Inhibitors (ACEIs) or Angiotensin Receptor Blockers (ARBs)**, are considered the antihypertensive agents of choice in patients with diabetes. This is because ACEIs and ARBs have been shown to:
* Reduce intraglomerular pressure and proteinuria, thereby slowing the progression of diabetic nephropathy.
* Not adversely affect glucose metabolism or insulin sensitivity.
* Provide cardiovascular benefits, including reducing the risk of myocardial infarction, stroke, and cardiovascular mortality.
## Why Each Wrong Option is Incorrect
* **Option A: Beta blockers** can mask symptoms of hypoglycemia and worsen insulin resistance, making them less ideal for patients with diabetes.
* **Option B: Calcium channel blockers** are effective antihypertensive agents but do not offer the same level of renal protection as ACEIs or ARBs in patients with diabetes.
* **Option D: Diuretics** can worsen glucose tolerance and increase uric acid levels, which may be detrimental in patients with diabetes.
## Clinical Pearl / High-Yield Fact
A key point to remember is that **ACEIs and ARBs are renoprotective** and should be considered first-line in patients with diabetes and hypertension, especially in those with proteinuria or kidney disease.
## Correct Answer: C. ACE inhibitors or ARBs.