Antihypertensive drugs in diabetes

Are any classes of antihypertensive drugs preferred in patients with diabetes?

Ally Prebtani, MD: It depends on whether the patient with diabetes has nephropathy or not.

If they have nephropathy, there is good evidence that the first consideration should be an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin-receptor blocker. If additional therapy is needed, consider a thiazide or thiazide-like diuretic or long-acting dihydropyridine calcium channel blocker.

If they do not have nephropathy, you can choose anything such as an ACE inhibitor, angiotensin-receptor blocker, a thiazide or thiazide-like diuretic, or dihydropyridine calcium channel blocker. You have many more options if they do not have nephropathy.