- Ministry of Health, Drug and Wellness Education
- Chronic Diseases: RX drug information updates for prevention and treatment.
- Women’s and children health medication information
- Men’s Health Medication Information
- Vaccination – Vaccine Contraindication and Precaution
- Natural and Herbal Medicines Update
- Drug Interactions and Medication Errors
- Medication: Information RX Patient Corrections
Diabetes: First-line drugs for Hypertension in Diabetes Patients
There is still some controversy about whether an ACEI or ARB should always
be the first-line for hypertension in diabetes patients. This has been the standard
of care for years. In fact, using ACEIs or ARBs in these patients can increase
Medicare Part D Star ratings.
But now JNC 8 Guideline says it is okay to use a Calcium Channel Blocker (CCB)
or thiazide first in diabetes patients because there is not enough strong evidence
that an ACEI or ARB leads to better CV outcome.
Other experts point out that diabetes patients are at risk for heart disease
and other conditions that benefit from an ACEI and ARB. LEAN toward an ACEI
or ARB first for hypertension in most diabetes patients, but do not be
overly concerned if some patients get a CCB or thiazide first.
As example, in AFRICAN AMERICANS, CCBs or Thiazides work better to lower
Stroke risk and BP than ACEIs or ARBs when used alone, with ONE EXCEPTION,
that is, in patients with chronic Kidney, INCLUDING African Americans. Recommend
an ACEI or ARB first because these drugs improve outcomes in patients with
Chronic Kidney disease.