2.4.2.3 Classes of Antihypertensive Medications.
Initial treatment for hypertension should include any of the drug classes demonstrated to reduce cardiovascular events in patients with diabetes: ACE inhibitors (52,53), ARBs (52,53), thiazide-like diuretics (54), or dihydropyridine calcium channel blockers (55). For patients with albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g), initial treatment should include an ACE inhibitor or ARB in order to reduce the risk of progressive kidney disease (17) (Fig. 10.1). In the absence of albuminuria, risk of progressive kidney disease is low, and ACE inhibitors and ARBs have not been found to afford superior cardioprotection when compared with thiazide-like diuretics or dihydropyridine calcium channel blockers (56). β-Blockers may be used for the treatment of prior MI, active angina, or heart failure but have not been shown to reduce mortality as blood pressure-lowering agents in the absence of these conditions (23,57).