Drug of choice in stage-I hypertension with diabetic nephropathy associated with frank Proteinuria is

(D) ACE inhibitor > In all types of kidney disease, renin-angiotensin system (RAS) blockade with ACE inhibitors is superior to alternative anti- hypertensive agents if proteinuria is present.> This is not the case in the absence of proteinuria.> Therefore, in diabetic patients with proteinuric kidney disease, albuminuria/proteinuria are treatment targets and indications for RAS blockade. In diabetic patients, both ACE inhibitors and angiotensin receptor blockers (ARBs) cause BP-independent reduction of the onset of microalbuminuria. In patients with proteinuric diabetic kidney disease, baseline proteinuria predicted both renal and cardiovascular end points; furthermore, lowering of proteinuria by ARBs was associated with significant reduction in renal and cardiovascular end points. In the Irbesartan in Diabetic Nephropathy Trial (IDNT), lowering proteinuria by more than 50% reduced the risk of adverse renal outcome by >50%. Assignment to irbesartan resulted in a 33% reduction in risk (P<.001) for reaching a renal end point beyond that achieved by lowering the systolic BP.> Even in patients who achieved a systolic BP <134 mm Hg, adverse renal outcomes were significantly reduced with irbesartan (12%) compared with amlodipine plus placebo (20%; relative risk, 0.55).> Effects of lower systolic BP and treatment with irbesartan were additive and completely independent, in line with the finding that in all types of proteinuric renal disease, both BP lowering and RAS blockade have beneficial effects on outcome.