Hypertension Management in Type 2 Diabetic Patients with Lisinopril Allergy

First-Line Treatment Options

The American Diabetes Association recommends angiotensin receptor blockers (ARBs) as the first-line treatment for patients with hypertension and type 2 diabetes who are allergic to lisinopril (ACE inhibitor) 1, 2
ARBs provide similar cardiovascular and renal protection benefits as ACE inhibitors without the same allergy risk, and are particularly important for patients with albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g creatinine) as they significantly reduce proteinuria and slow progression of diabetic kidney disease 3, 1

The American Diabetes Association recommends determining baseline blood pressure and level of albuminuria before starting therapy, and checking renal function (serum creatinine/eGFR) and potassium levels 1
For blood pressure 140-159/90-99 mmHg, the American Diabetes Association recommends starting with ARB monotherapy 2, 4
For blood pressure ≥160/100 mmHg, the American Diabetes Association recommends beginning with ARB plus another agent (preferably a thiazide-like diuretic or dihydropyridine calcium channel blocker) 1, 2

The American Diabetes Association recommends titrating ARB to maximum tolerated dose indicated for blood pressure treatment, and monitoring serum creatinine/eGFR and potassium levels at least annually 2, 1

The American Diabetes Association recommends a blood pressure target of <130/80 mmHg for most patients with diabetes and hypertension 1, 2
The American Diabetes Association recommends never combining an ARB with an ACE inhibitor or direct renin inhibitor due to increased risk of adverse effects without added benefit 1, 2
The American Diabetes Association recommends monitoring for hyperkalemia, especially if adding a mineralocorticoid receptor antagonist to an ARB 1, 4