In managing hypertension in a diabetic patient, which medication is the most appropriate as initial treatment?

In managing hypertension in a diabetic patient, the most appropriate initial treatment is the use of lisinopril. This medication is an angiotensin-converting enzyme (ACE) inhibitor, which not only effectively lowers blood pressure but also provides renal protective benefits, particularly important for diabetic patients who are at increased risk for diabetic nephropathy.

Lisinopril helps reduce the progression of kidney disease in diabetes by decreasing intraglomerular pressure, ultimately preserving kidney function. Additionally, ACE inhibitors have been shown to improve outcomes in patients with diabetes, making them a first-line choice in this population.

In contrast, other options like terazosin primarily work as alpha-blockers, atenolol as a beta-blocker, and hydrochlorothiazide as a diuretic, which may not provide the same renal protective effects or may have other considerations that make them less ideal for initial therapy in a diabetic context. For example, beta-blockers may mask symptoms of hypoglycemia, and diuretics can cause issues like electrolyte imbalances, particularly in higher doses. Therefore, lisinopril stands out as the preferred medication due to its dual action on hypertension and kidney protection in diabetic patients.