MEDizzy - You are seeing an African-American man with newly diagnosed

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Chronic conditions

You are seeing an African-American man with newly diagnosed diabetes. His blood pressure at the last visit was 148/76 mm Hg, and at this visit it is 152/82 mm Hg. He has no evidence of CVD or CKD and is not on any antihypertensive agents. Which of the following statements is true regarding the use of an ACE-inhibitor in this patient?

ExplanationACE-inhibitors are clearly the first choice for blood pressure control in diabetic patients with CKD. They control blood pressure effectively, help prevent progression of renal disease, and are indicated in the presence of coronary disease and CHF. Although compelling, there is insufficient evidence to recommend ACE-inhibitors in all diabetic patients. According to the Eighth Joint National Committee (JNC-8) guidelines, African- American patients with T2DM without albuminuria and blood pressure readings between 140/90 and 160/100 mm Hg should receive either a thiazide-type diuretic or a calcium channel blocker alone or in combination as initial treatment. If albuminuria is present, an ACE or an ARB should be considered first. Among these four classes of medication, the ADA guidelines don’t specify a preferred initial agent unless albuminuria is present, then they recommend an ACE or ARB preferentially. ACE/ARBs can be used irrespective of creatinine levels, though potassium should be monitored as creatinine rises.