MEDizzy - A diabetic male presents with hypertension. His blood

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Nephrology

A diabetic male presents with hypertension. His blood pressure is 146/92. He has no peripheral edema but does note sensory loss to the mid- calves bilaterally. A spot urine specimen shows 150 micrograms of albumin per mg creatinine (microalbuminuria present if this value is 30-300 mcg/mg). Which of the following is the most appropriate antihypertensive drug to prevent the progression of renal failure?

Explanation By a variety of mechanisms, angiotensin-converting enzyme inhibitors help to preserve renal function in diabetes. Angiotensin receptor blockers can be used as well. Be sure to monitor serum potassium and serum creatinine after initiation of therapy. Clonidine has not been shown to slow the progression of diabetic renal disease and often causes orthostatic hypotension, constipation, and erectile dysfunction. Although many diabetic patients receive beta-blockers because of coronary disease, these are not first-line drugs for preventing the progression of renal failure. Beta-blockers may blunt the symptoms and physiologic response to hypoglycemia, but this is primarily a problem in brittle insulin-treated diabetics. Because of its low cost and proven efficacy, thiazide diuretics remain a good choice for the general population but do not have a specific effect on the progression of renal disease. Short-acting dihydropyridine cal- cium-channel blockers (eg, nifedipine) may increase the incidence of stroke and myocardial infarction, and have no role in the treatment of hypertension in any patient.