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Albuminuric diabetic CKD hypertension — ESENeph MCQ

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EasyHypertension and Renovascular DiseaseAlbuminuric diabetic CKD hypertensionESENeph

A 60-year-old man with CKD G3b and diabetes is reviewed after a myocardial infarction. eGFR is 38 mL/min/1.73 m², ACR is 64 mg/mmol and potassium is 4.7 mmol/L. He is taking statin, beta-blocker and aspirin; blood pressure is 152/86 mmHg. What is the most appropriate renal-protective blood pressure strategy?

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Correct answer: D — Use ACE inhibitor or ARB and titrate to tolerated dose

Albuminuric diabetic CKD benefits from ACE inhibitor or ARB therapy titrated as tolerated, with monitoring of creatinine and potassium. eGFR below 45 is not a contraindication in itself. Alpha-blocker or loop diuretic monotherapy may lower pressure but lacks the same proteinuria and renal-protection evidence. The pearl is that cardiovascular risk reduction and albuminuria reduction are inseparable in CKD care.

Reference: NICE NG203; KDIGO 2024 CKD Guideline