A 60-year-old hypertensive patient with Type 2 diabetes and microalbuminuria is to be started on an antihypertensive that also provides renoprotection. Which class of drugs is the MOST appropriate first choice?

• A Thiazide diuretics
• B Dihydropyridine calcium channel blockers
• C ACE inhibitors or ARBs ✓
• D Cardioselective beta-blockers

Explanation

ACE inhibitors and ARBs reduce intraglomerular pressure by dilating the efferent arteriole preferentially through blockade of angiotensin II effects, reducing proteinuria and slowing progression of diabetic nephropathy. Multiple landmark trials (IDNT, RENAAL, MICROHOPE) confirm renoprotection independent of the degree of blood pressure lowering. Thiazides and calcium channel blockers lower blood pressure but lack specific renoprotective mechanisms in diabetic nephropathy. Beta-blockers are generally less preferred in diabetics due to masking of hypoglycaemic symptoms.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.