JNC8 HTN/DM/ACEi confusion

[bdc142]

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Hi all - i'm confused about JNC8 criteria for HTN regarding african americans. According to the guidelines, for AA + DM but no CKD, you should *not* adminster ACEi as initial therapy. However, if they are AA + CKD then you can administer ACEi as initial therapy.

Where exactly does diabetic nephropathy (e.g. albuminurea, increased BUN/creatinine) fall under? DM or CKD? I had a pt earlier today who had slightly increased Cre, but no microalbuminurea - my attending, still prescribed ACEi even though he considered the pt to not have CKD.

Any input would help, much appreciated!

 

[notbobtrustme]

I don't think it matters because once you have microalbuminurea or increased Cr; that person gets an ACE-i.

I'd consider it a complication of DM until you can be formally diagnosed with Stage 1 CKD.

On a side note, JNC8 is ridiculous.