Among patients with diabetes and hypertension, which antihypertensive class is preferred to slow progression of kidney injury?

• A. ACE inhibitors
• B. Beta blockers
• C. Direct-acting vasodilators
• D. Thiazide diuretics

Answer: (A)

ACE inhibitors are preferred because they protect the kidneys specifically in diabetes by lowering intraglomerular pressure and reducing proteinuria. By blocking angiotensin II, they dilate the efferent arteriole, which decreases glomerular capillary pressure, slows the progression of diabetic nephropathy, and helps preserve kidney function over time. This renoprotective effect is why they outperform other antihypertensives like beta blockers, direct-acting vasodilators, or thiazide diuretics in slowing kidney injury in patients with diabetes and hypertension. Beta blockers mainly reduce heart rate and BP without renoprotection, direct-acting vasodilators can cause reflex sympathetic activation and fluid retention, and thiazides lower BP but don’t provide the same kidney-protective benefits.