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antihypertensive drug of choice diabetic hypertensive patient ACE inhibitor ARB first line
Answer: A) Losartan
In a patient with type 2 diabetes who develops essential hypertension, an ACE inhibitor or ARB (like losartan) is the antihypertensive of choice - not because of superior BP-lowering (all four options lower BP effectively) but because of renoprotection:
- Losartan (ARB) blocks the RAAS, reducing efferent arteriolar resistance in the glomerulus, which lowers intraglomerular pressure and albuminuria, and slows progression of diabetic nephropathy independent of its BP effect.
- Thiazides (hydrochlorothiazide) can worsen glucose tolerance and dyslipidemia, and are usually add-on rather than first choice in this setting.
- Beta-blockers (atenolol) can mask hypoglycemia symptoms and negatively affect lipid/glucose metabolism, so they're avoided as first-line here.
- Amlodipine (dihydropyridine CCB) is a reasonable add-on but doesn't have the specific renoprotective, albuminuria-reducing effect that ACEI/ARBs have.
This aligns with major guidelines (e.g., ADA Standards of Care), which recommend ACE inhibitors/ARBs as first-line antihypertensive therapy in diabetics, especially once there's any degree of albuminuria, because of their proven benefit in slowing diabetic kidney disease progression - a benefit that's a class effect distinct from other antihypertensives.
So the correct choice is A) Losartan.
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