The ADA recommends ACE inhibitors as the first agent of choice to lower blood pressure given its renal protective effect and neutral effect on glucose and lipids. ACE inhibitors decrease peripheral arterial resistance and increase cardiac output. While loop and thiazide diuretics are often first- line therapy for blood pressure, they can worsen glucose and lipid levels at high doses. The choice of agent is based on the overall patient profile and physician assessment. If lipid goals are not achievable through exercise, medical nutrition therapy, glucose control, and weight loss, then pharmacologic intervention is indicated.
Statins reduce the production or increase the breakdown of LDLs.
Resins work by increasing the clearance of cholesterol-rich lipoproteins from the plasma. Current strategies include diet therapy, exercise, and smoking cessation. Medications such as niacin and statins have been shown to have a modest effects on increasing HDLs. 2 Niacin unfortunately has hyperglycemia as one of its side effects, so it should be used with caution. Since triglyceride levels are affected by glucose levels, improved glucose control is a first-line strategy to decrease triglyceride levels.