A 40 year old male patient is suffering from type II diabetes mellitus and hypeension. Which of the following antihypeensive drugs should not be used in such patients :
Answer is B (Hydrochlohiazide) Hydrochlohiazide is not a preferred agent for the treatment of hypeension in diabetics as it causes unorable alteration in glucose and lipid profile of the patient. `Hyperglycemia and hyperlipidemia have been repoed with the use of diuretics as antihypeensives' -- KDT Antihypeensive drugs in diabetics: 'ACE inhibitors or angiotensin receptor blockers are the first line agents for management of hypeension in diabetics' -- Harrison 16th/ 1479 Lisinopril & Trandalopvil are examples of ACE inhibitors while Losaan is an angiotensin receptor blocking agent. These have no known adverse effects on glucose or lipid metabolism and minimize the development of diabetic nephropathy by reducing renal vascular resistance and renal perfusion pressure. What puzzles the situation: In Diabetic patient with hypeension multiple agents are usually needed to achieve good blood pressure control. The average diabetic patient will require at least three medications to achieve appropriate control. While ACE inhibitors/ angiotensin receptor blockers will form an essential component of the regimen, Thiazide diuretics may also be used as an additional agent. Thus diuretics though not preferred agents for treatment of hypeension in diabetics, may well be used as conjunctive agents and are a possible treatment modality. Neveheless they are the single best answer to exclude amongst the options provided here.
Lisinopril
Hydrochlohiazide
Losaan
Trandolopril