Which antihypertensive medications are recommended for type 2 diabetes mellitus (DM)?

Updated: Oct 23, 2019
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

While angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), diuretics, beta blockers, and calcium channel blockers are all considered acceptable initial therapy, the author prefers inhibitors of the renin-angiotensin system (ie, ACE inhibitors, ARBs) because of their proven renal protection effects in patients with diabetes. Many patients require multiple agents. Diuretics or calcium channel blockers frequently are useful as second and third agents.

The ALTITUIDE Trial investigating the impact of direct renin inhibitor with aliskiren on cardio-renal outcomes in patients with diabetes mellitus when used as an adjunct to angiotensin converting enzyme inhibitor or angiotensin receptor blocker therapy failed to show any benefit. On the contrary, it might be harmful due to an increased risk for hyperkalemia and hypotension despite marked reduction in proteinuria. [289]


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