What is the first-line treatment for hypertension in a patient with diabetes?

In patients with diabetes, the first-line treatment for hypertension is an ACE inhibitor. This choice is based on the substantial body of evidence demonstrating that ACE inhibitors not only effectively lower blood pressure but also provide specific renal protective benefits in diabetic patients.

Diabetes can lead to nephropathy, and ACE inhibitors have been shown to reduce the progression of kidney disease by decreasing intraglomerular pressure through their effects on the renal vasculature. They achieve this by inhibiting the conversion of angiotensin I to angiotensin II, which results in vasodilation and decreased secretion of aldosterone, leading to reduced sodium and water retention.

Additionally, the use of ACE inhibitors is recommended in guidelines for managing hypertension in individuals with diabetes due to their favorable impact on cardiovascular outcomes. Therefore, when treating a patient with both hypertension and diabetes, ACE inhibitors are preferred not just for blood pressure control, but also for their protective effects on the cardiovascular and renal systems.