Why are ACE inhibitors the drug class of choice for controlling hypertension in patients with diabetes mellitus?

ACE inhibitors are considered the drug class of choice for controlling hypertension in patients with diabetes mellitus primarily because they provide significant renal protection. Diabetes can lead to diabetic nephropathy, a condition where the kidneys suffer damage over time due to high blood sugar levels. ACE inhibitors help to reduce the progression of kidney damage by lowering intraglomerular pressure and improving blood flow, which is particularly crucial for diabetic patients.

By inhibiting the renin-angiotensin-aldosterone system (RAAS), ACE inhibitors help to decrease blood pressure while also offering protective effects on the kidneys. This becomes essential in diabetic individuals who are at increased risk for kidney complications. Additionally, ACE inhibitors can reduce proteinuria, which is an important marker of kidney damage.

While cost, insulin sensitivity, and heart rate may be important considerations in different aspects of patient management, the specific renal protective benefits provided by ACE inhibitors are the critical reason they are preferred in the management of hypertension in individuals with diabetes. The protective effect on the kidneys helps to prevent or slow the progression of renal complications associated with diabetes, thereby enhancing the overall health and longevity of the patient.