Diabetic nephropathy management

Captopril is a sulfhydryl-containing ACE inhibitor used in the management of hypertension and heart failure, after myocardial infarction, and in diabetic nephropathy. 

Answer A. ACEIs slow the progression of diabetic nephropathy and are indicated for management of HTN in such patients. Nitroprusside is used IV in severe HTN or hypertensive crisis, not for management of mild-to-moderate HTN. Losartan, which blocks AT-1 receptors, is associated with teratogenic effects during fetal development, as are the ACEIs. Nonselective beta blockers are not ideal for patients who suffer from peripheral vascular disease, diabetes, or asthma. Reserpine causes the release of amines from tumor cells, exacerbating HTN in pheochromocytoma. 

Captopril, an angiotensin-converting enzyme inhibitor (ACE), is indicated in the management of hypertension by itself or in combination with other antihypertensive medications, in heart failure when the patients have not responded adequately to digitalis, after myocardial infarction associated with left ventricular dysfunction, and in diabetic nephropathy (Figure 25). 

Crook, E.D. and Penumalee, S. 2004. Therapeutic controversies in hypertension management angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers in diabetic nephropathy ACE inhibitors. Ethnicity disease, 14(4), S2-1-4. 

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