Which antihypertensive drug class is preferred in patients with hypertension and diabetes mellitus?

• A. ACE inhibitors or ARBs
• B. Thiazide diuretics
• C. Beta blockers
• D. Alpha-adrenergic blockers

Answer: (A)

When diabetes is present, protecting the kidneys becomes a top priority in managing hypertension. Drugs that block the renin-angiotensin system—ACE inhibitors or ARBs—are favored because they reduce intraglomerular pressure and lessen protein leakage into the urine, slowing the progression of diabetic nephropathy. They also provide meaningful cardiovascular protection, which is especially important since diabetes increases cardiovascular risk.

Other options don’t offer the same kidney and metabolic advantages. Thiazide diuretics can worsen glucose tolerance and lipid levels; beta blockers may blunt warning signs of hypoglycemia and have less favorable metabolic effects; alpha-adrenergic blockers don’t provide the same renal benefits. For these reasons, ACE inhibitors or ARBs are the preferred first-line choice in patients with hypertension and diabetes.