First drug of choice in a patient with Diabetes mellitus and concomitant hypertension?
Ans. d. ACE inhibitors (Ref. Harrison's Internal medicine 17th edition, p. 1558; 16th edition, p. 1479)Antihypertensive therapy:Primary (essential) hypertensionDiuretics, ACE inhibitors, angiotensin li receptor blockers (ARBs), calcium channel blockers.Hypertension with CHFDiuretics, ACE inhibitors/ARBs, b-blockers (compensated CHF), aldosterone antagonists, p-blockers must be used cautiously in decompensated CHF and are contraindicated in cardiogenic shock.Hypertension with diabetes mellitusACE inhibitors/ARBs. Calcium channel blockers, diuretics, b-blockers, a-blockers.ACE inhibitors/ARBs are protective against diabetic nephropathy.ACE INHIBITORS AND DM# No adverse effect on glucose and lipid metabolism# No depression / sexual dysfunction# Lower intraglomerular pressure & retards diabetic nephropathy by 50%ACE INHIBITORSMECHANISMCLINICAL USETOXICITYCaptopril, enalapril, lisinopril.loss of feedback inhibition.Inhibition of ACE also prevents inactivation of bradykinin, a potent vasodilator.Hypertension, CHF, proteinuria, diabetic nephropathy. Prevent unfavorable heart remodeling as a result of chronic hypertension.Cough, Angioedema (contraindicated in Cl esterase inhibitor deficiency), Teratogen (fetal renal malformations), | Creatinine (|GFR),Hyperkalemia, and Hypotension. Avoid in bilateral renal artery stenosis, because ACE inhibitors will further |GFR -renal failure. Also remember:
Calcium channel blockers
a-adrenergics
b-adrenergics
ACE inhibitors
Endocrinology