What is the first-line therapy for a 54-year-old diabetic patient with hypertension and renal impairment?

The first-line therapy for a diabetic patient with hypertension and renal impairment is indeed ACE inhibitors. This choice is based on multiple factors related to their pharmacological properties and the underlying clinical scenarios.

ACE inhibitors, such as lisinopril or enalapril, have been shown to provide renal protective effects, particularly in patients with diabetes. Diabetic nephropathy is a common complication in diabetic patients, and controlling blood pressure is crucial to slow the progression of renal impairment. ACE inhibitors reduce intraglomerular pressure, which helps to protect the kidneys from damage.

Additionally, they have beneficial effects on cardiovascular outcomes, which is particularly important for diabetic patients who often have an increased risk of cardiovascular disease. By reducing blood pressure and offering renal protection, ACE inhibitors address two critical concerns in the management of this patient's condition.

Other options, while they may be beneficial in certain contexts, do not specifically offer the dual advantages of renal protection and effective blood pressure control in this situation.