first line management of hypertension in patient with ckd and diabetes?

For adults starting antihypertensive treatment who have type 2 diabetes, the first-line treatment should be an ACE inhibitor or an ARB ¹. If an ACE inhibitor is not tolerated, an ARB should be offered ¹. It is important not to combine an ACE inhibitor with an ARB ¹. For adults with hypertension and chronic kidney disease, the choice of antihypertensive drug treatment should be guided by NICE's guideline on chronic kidney disease ¹. Blood pressure targets:

• For adults under 80 with hypertension and type 2 diabetes, or chronic kidney disease with an albumin to creatinine ratio of 70 mg/mmol or more, the clinic blood pressure target is below 130/80 mmHg ¹.
• For adults aged 80 and over with hypertension and type 2 diabetes, the clinic blood pressure target is below 150/90 mmHg ¹.
• For adults aged 80 and over with chronic kidney disease and an albumin to creatinine ratio of 70 mg/mmol or more, the clinic blood pressure target is below 130/80 mmHg ¹.

For specialist consideration:

• When choosing antihypertensive drug treatment for adults of Black African or African–Caribbean family origin with hypertension and type 2 diabetes, consider an ARB in preference to an ACE inhibitor ¹.
• If there is evidence of heart failure, offer a thiazide-like diuretic and follow NICE's guideline on chronic heart failure ¹.
• If starting or changing diuretic treatment, offer a thiazide-like diuretic, such as indapamide, in preference to a conventional thiazide diuretic ¹.