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Hypertension with diabetic kidney disease — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareHypertension with diabetic kidney diseaseUSMLE Step 3

A 58-year-old man comes to the office for follow-up of hypertension. Home blood pressure readings over 2 weeks average 151/92 mm Hg. He has type 2 diabetes and chronic kidney disease with estimated GFR 54 mL/min/1.73 m2. Urine albumin-creatinine ratio is 160 mg/g. He takes amlodipine 10 mg daily and has no edema. Which of the following is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Add lisinopril

ACE inhibitor or ARB therapy is preferred for hypertension with diabetes and albuminuric chronic kidney disease.

Reference: 2025 AHA/ACC High Blood Pressure Guideline; ACC/AHA primary prevention guidance