A hypertensive patient with Type 2 diabetes and microalbuminuria is best treated with which antihypertensive to simultaneously retard the progression of diabetic nephropathy?
- A Amlodipine alone, as calcium channel blockers reduce glomerular pressure
- B ACE inhibitor or ARB, as they reduce intraglomerular pressure through efferent arteriole dilation ✓
- C Beta-blocker, as they reduce renal sympathetic tone and renin secretion
- D Thiazide diuretic, as they reduce plasma volume and proteinuria directly
Correct answer: B. ACE inhibitor or ARB, as they reduce intraglomerular pressure through efferent arteriole dilation
Explanation
ACE inhibitors and ARBs block the renin-angiotensin system, causing preferential dilation of the efferent arteriole (angiotensin II preferentially constricts efferent > afferent). This reduces intraglomerular capillary pressure, decreasing filtration fraction and proteinuria. They have proven reno-protective benefit in diabetic nephropathy independent of blood pressure lowering, slowing progression to ESRD. Dihydropyridine CCBs (amlodipine) dilate afferent arteriole more and may worsen proteinuria if used alone.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.