Which antihypertensive class is first-line and renal protective in diabetes?

• A. Beta blockers.
• B. ACE inhibitors.
• C. Calcium channel blockers.
• D. Diuretics.

Answer: (B)

High blood pressure in diabetes should be treated with a strategy that protects the kidneys as well as lowers BP. ACE inhibitors fit that need because they block the formation of angiotensin II, which reduces the pressure inside the glomeruli by dilating the efferent arterioles. That decrease in intraglomerular pressure lowers protein leakage (albuminuria) and slows the progression of diabetic nephropathy, helping preserve kidney function over time. This renal-protective effect makes ACE inhibitors the preferred first-line choice for hypertension in people with diabetes, especially when there is evidence of kidney involvement. Other classes can lower blood pressure, but they don’t offer the same targeted kidney protection in this setting, and some can worsen glucose control or have other metabolic downsides. If an ACE inhibitor isn’t tolerated (for example, due to cough), an ARB is a common alternative with similar renal benefits.