For diabetic nephropathy (as evidenced by her microproteinuria), ACE inhibitors or angiotensin receptor blockers (-sartans, such as irbesartan) are first line for preventing progression of the disease. They also help to further control blood pressure. Thus, an ARB would be the best choice of the answers given.
regularstudentI was under the impression that African-Americans did not respond well to ACE inhibitors and ARBS. Our school taught us this pretty early on, and made sure we didn't forget. That's why I chose amlodipine. Bummer!+6
pranspach^Yes, I believe African-Americans may respond to other treatments more so than ACEI/ARB (because they are relatively lower renin producers, if I remember correctly) such as calcium blockers and hydralazine (per Sketchy) for simple hypertension; HOWEVER, since the patient also has diabetic nephropathy, ACEI/ARB also decrease intraglomerular pressure in addition to addressing the hypertension.
FA2019 pg 596 for ACEI, pg312 for table on hypertension treatments.+3
jj375My school made sure we knew that it works in the African American Population but it just reduces BP less than it would in the white population. However its kidney protective benefits are still there! They said to just know that often we would need to add a second medication along with the ACEi or ARB for the African American Population or maybe use a different dose - it is super important to know that we still should use it in this population due to its important benefits. Here is a link to an article about it! https://pubmed.ncbi.nlm.nih.gov/10893650/#:~:text=Angiotensin%20converting%20enzyme%20(ACE)%20inhibitors,lowering%20efficacy%20in%20this%20population.+
submitted by โcassdawg(1780)
For diabetic nephropathy (as evidenced by her microproteinuria), ACE inhibitors or angiotensin receptor blockers (-sartans, such as irbesartan) are first line for preventing progression of the disease. They also help to further control blood pressure. Thus, an ARB would be the best choice of the answers given.