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Hypertensive Nephropathy — RACP Adult Medicine MCQ

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EasyCardiologyHypertensive NephropathyRACP Adult Medicine

A 60-year-old man is found to have a blood pressure of 178/105 mmHg on three separate occasions. He has type 2 diabetes and an eGFR of 55 mL/min/1.73m² with albumin:creatinine ratio of 35 mg/mmol. Which antihypertensive class is the most appropriate first-line agent?

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Correct answer: E — ACE inhibitor

ACE inhibitors are first-line for hypertension in patients with diabetic kidney disease and albuminuria. They provide both BP reduction and renoprotective effects by reducing intraglomerular pressure and proteinuria. ARBs are an alternative if ACEi is not tolerated.

Reference: NHFA – 2016 – Hypertension Guidelines; KDIGO 2024 CKD Guidelines