A. ACE inhibitor – Explanation

This question is really testing your management of hypertension with diabetes.

Patients with type 2 diabetes mellitus have a considerably higher risk of cardiovascular morbidity and
mortality, not to mention hypertension plays a major role in the development and progression of
microvascular and macrovascular disease in people with diabetes. Treatment in this group of patients is
especially important.

The management for a person with hypertension alone differs slightly when compared to the
management of a patient with hypertension and diabetes.

First-line antihypertensive drug treatment in a hypertensive patient with diabetes should be an ACE
inhibitor unless the patient is Afro-Caribbean. Age here is irrelevant when the patient has diabetes.
Given the benefits of ACE inhibitors in terms of reno-protection and retinopathy, it is appropriate to
recommend an ACE inhibitor as first line for the treatment of hypertension in most adults with type 2
diabetes. This is partly due to the positive effect on glucose metabolism.

For people of African or Caribbean family origin, an ACE inhibitor plus either a diuretic or a calcium
channel blocker is first line.

HYPERTENSION MANAGEMENT IN NONDIABETICS AND DIABETICS