[Antihypertensive therapy in diabetes mellitus]

Area of Science:

• Nephrology
• Endocrinology
• Cardiology

Context:

• Diabetic nephropathy is the primary cause of end-stage renal disease globally.
• Type II diabetes mellitus accounts for 90% of diabetes cases and is a significant risk factor for kidney disease.
• Hypertension often coexists with type II diabetes, leading to complex renal lesions.

Purpose:

• To review current understanding and treatment strategies for hypertension in diabetic patients with and without nephropathy.
• To highlight the role of various antihypertensive drug classes in managing diabetic kidney disease.
• To provide evidence-based recommendations for blood pressure targets and medication choices.

Summary:

• For diabetics without nephropathy, preferred antihypertensives include ACE inhibitors, angiotensin II-receptor antagonists, non-dihydropyridine calcium channel blockers, and indapamide due to their favorable metabolic profiles.
• Established diabetic nephropathy requires a blood pressure target of 120/80 mmHg, primarily managed with ACE inhibitors or angiotensin II-receptor antagonists, with caution in elderly patients with atherosclerosis.
• Non-dihydropyridine calcium channel blockers (verapamil, diltiazem) show promise in preserving renal function, and a fixed-dose combination of trandolapril with verapamil is available for resistant cases. Indapamide is noted for its unique nephroprotective diuretic properties.

Impact:

• Informs clinical practice regarding optimal antihypertensive therapy selection for diabetic patients.
• Emphasizes the importance of individualized treatment based on the presence and severity of diabetic nephropathy.
• Contributes to the prevention and management of end-stage renal disease in the growing diabetic population.