A 52-year-old man on hydrochlorothiazide and amlodipine has BP 158/96 mmHg. He has an eGFR of 62 mL/min, urine protein:creatinine ratio of 0.45 g/g, and no diabetes. What antihypertensive class should be added as the third agent to maximally protect his kidneys?
- A Beta-blocker
- B ACE inhibitor or ARB ✓
- C Alpha-blocker
- D Mineralocorticoid receptor antagonist
Correct answer: B. ACE inhibitor or ARB
Explanation
In hypertensive patients with proteinuric CKD (urine protein:creatinine ratio ≥0.3 g/g is significant), ACE inhibitors or ARBs provide reno-protection beyond BP control through reduction of intraglomerular hypertension via efferent arteriolar dilation. KDIGO 2021 guidelines recommend ACE inhibitor or ARB as a component of antihypertensive therapy in CKD with proteinuria. They are superior to other antihypertensive classes in slowing CKD progression and reducing proteinuria. Beta-blockers and alpha-blockers lack specific renoprotective indication in proteinuric CKD.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.