ACE Inhibitors (ACEi)/Angiotensin Receptor Blockers (ARBs):

• Recommended first-line therapy for hypertension in people with diabetes and coronary artery disease.
• Remain first-line, especially with albuminuria (≥300 mg/g creatinine) or CKD.
• Contraindication Alert: Avoid dual RAS blockade (ACEi + ARB) due to hyperkalemia and AKI risks
• e.g., Lisinopril: 10–40 mg once daily
• e.g., Losartan: 50–100 mg once daily. Use if intolerant to ACEi

Thiazide-like Diuretics

• e.g., Chlorthalidone: 12.5–25 mg once daily
• Avoid if eGFR <30 mL/min/1.73 m²

Calcium Channel Blockers (CCBs)

• e.g., Amlodipine: 5–10 mg once daily
• Useful in Black patients or if proteinuria absent
• 
  

Combination Therapy (if BP ≥160/100 mmHg)

• Preferred combo: ACEi or ARB + CCB or thiazide-like diuretic

BP ≥130/80 mmHg on three antihypertensives, including a diuretic.

Management:

Add finerenone (non-steroidal MRA) for diabetic CKD (eGFR ≥25 mL/min/1.73m²) to reduce CVD/renal events.

Fourth-Line Options: Amiloride, hydralazine, or renal denervation for refractory cases.

Secondary Causes: Screen for primary aldosteronism, renal artery stenosis, and OSA.

Albuminuria (UACR ≥30 mg/g):
Use ACEi or ARB as first-line agent regardless of BP level.

Chronic Kidney Disease (eGFR <60):
ACEi or ARB + close monitoring of serum potassium and creatinine.

Elderly patients:
Avoid overtreatment; monitor for orthostatic hypotension.

Pregnancy:

·        First-line: Labetalol, nifedipine, or methyldopa.

·        Contraindicated: ACEi, ARBs, finerenone.