According to the American Diabetes Association, use either an ACE inhibitor or ARB as the first-line treatment of hypertension in patients with diabetic nephropathy. However, one agent alone is unlikely to control this patient's hypertension. At his level of eGFR, a thiazide diuretic is unlikely to be very effective. Therefore, a loop diuretic should be initiated with the ACE inhibitor or ARB, especially since he has edema.
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Cite this: Anne L. Peters, Pradeep Arora. Skill Checkup: A 64-Year-Old Man With Type 2 Diabetes, Dyspnea, Pruritus, and Pitting Edema of the Bilateral Extremities - Medscape - Dec 20, 2022.