An elderly hypeensive has diabetes mellitus and bilateral renal aery stenosis. The best management is -

Ans. is 'b' i.e., Verapamil o ACE inhibitors are the most appropriate antihypeensives in patients with diabetes, nephropathy, left ventricular hyperophy, CHF, angina and post MI cases. o But ACE inhibitors are contraindicated in bilateral renal aery stenosis. o CCBs are next to ACE inhibitors in reducing albuminuria and slowing disease progression in diabetic nephropathy. o Therefore a CCBs (verapamil) should be given to this patient. Remember o Thiazide diuretic with added If+ sparing diuretic is the first choice treatment of essential hypeension.