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78-year-old woman with type 2 diabetes, diabetic nephropathy, and hyperuricemia presents to her physician for
a physical examination, which is remarkable for hypertension. Which of the following drugs would be best for the
initial treatment of this woman's hypertension?
A. Atenolol
B. Captopril
C. Hydrochlorothiazide
D. Indapamide
E. Minoxidil
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The correct answer is B. The question is essentially asking, "Which of the following agents would be
recommended in a women with diabetic nephropathy and hyperuricemia?" The angiotensin-converting enzyme
(ACE) inhibitors, such as captopril, are commonly recommended for the treatment of hypertension in diabetic
patients, especially those with renal complications, since these agents have been shown to delay the
progression of renal disease. Furthermore, these agents are generally well tolerated.
Atenolol (choice A) is a beta-1 adrenergic antagonist that is generally not recommended for diabetic patients
since it can "block" the appearance of the normal signs and symptoms of hypoglycemia.
The thiazide diuretics, such as hydrochlorothiazide (choice C) and indapamide (choice D), are commonly
associated with hyperuricemia. Furthermore, they can precipitate an acute gout attack in patients with
hyperuricemia.
Minoxidil (choice E) is a direct acting vasodilator most commonly used in the treatment of severe refractive
hypertension because of its profound side effect profile. This agent is rarely used as an initial treatment agent.
