A diabetic male presents with hypeension and 24-h urine showing 200 mg of albumin. In a diabetic patient with microalbuminuria, the appropriate drug for treatment of hypeension to prevent progression of renal failure is

By a variety of mechanisms, angiotensin conveing enzyme inhibitors help to preserve renal function in this situation. Two caveats: be sure to monitor serum potassium, and, in the older patient with potential renal vascular disease, monitor serum creatinine after initiation of therapy. Although many diabetic patients receive beta blockers due to coronary disease, these are not first-line drugs for preventing progression of renal failure. Caution is necessary in using beta blockers, as they may blunt the symptoms and physiologic response to hypoglycemia. Because of low cost and proven efficacy, thiazide diuretics remain a good choice for the general population, but do not have a specific effect on progression of renal disease. Sho-acting dihydropyridine calcium channel blockers (nifedipine) may increase the incidence of stroke and myocardial infarction, and have no role in the treatment of hypeension.