How should a patient with type 2 diabetes and hypertension be managed if she has microalbuminuria?

In patients with type 2 diabetes, the presence of microalbuminuria indicates an increased risk of cardiovascular disease and progression to diabetic nephropathy. The management of hypertension in such patients is critical in reducing these risks.

Starting lifestyle modifications is beneficial for all patients with hypertension, particularly those with diabetes, as weight loss, diet changes, and increased physical activity can improve overall health and assist with blood pressure control.

Adding lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is particularly important in this context due to its renal protective effects. ACE inhibitors are known to decrease intraglomerular pressure, which helps prevent the progression of kidney disease in patients with diabetes. Additionally, they can have favorable effects on blood pressure and cardiovascular outcomes, making them an ideal choice for managing hypertension in a patient with microalbuminuria.

Lisinopril helps to not only manage the hypertension but also serves to protect the patient’s renal function by mitigating the effects of diabetes-related kidney damage. This aligns with current guidelines recommending the use of ACE inhibitors or angiotensin receptor blockers (ARBs) in diabetic patients with microalbuminuria or overt nephropathy.

Other options may not provide the same level of renal protection or cardiovascular benefit