What is the recommended initial therapy for a 59-year-old patient with hypertension and diabetes?

For a 59-year-old patient with both hypertension and diabetes, the recommended initial therapy typically involves an ACE inhibitor, such as enalapril. ACE inhibitors are favored in this population due to their ability to provide renal protective effects, which is particularly beneficial for diabetic patients. They help control blood pressure effectively while also reducing the risk of diabetic nephropathy, a common complication of diabetes.

Enalapril works by inhibiting the angiotensin-converting enzyme, leading to vasodilation, decreased blood volume, and ultimately reduced blood pressure. Additionally, they have cardioprotective properties, further benefiting patients with concurrent hypertension and diabetes.

Other options, while potentially effective in treating hypertension, do not provide the same protective effects for renal health or may not be the first choice in patients with diabetes. For example, hydralazine is typically used for more resistant hypertension and is not first-line therapy. Verapamil, a calcium channel blocker, can lower blood pressure but is less specifically indicated for patients with diabetes compared to ACE inhibitors. Metoprolol, a beta-blocker, is mainly used in specific cases and may not have the same protective effects on the kidneys as ACE inhibitors do in diabetic patients. Therefore, the initial approach is to