Antihypertensive drugs and diabetic nephropathy

Diabetic nephropathy is the most common cause of end-stage renal disease in the United States. Hypertension is a major risk factor that predisposes individuals with diabetes to the development of renal disease and is very common in patients with diabetes. The benefit of blood pressure control on the rate of progression of diabetic nephropathy is being increasingly demonstrated in both type 1 and type 2 diabetic patients. Angiotensin converting enzyme inhibitors have proven renoprotective benefits in human studies, but the results of studies with calcium channel blockers are somewhat inconclusive. The other classes of antihypertensives also may have certain indications in the population of patients with diabetic nephropathy. In this paper we will critically review current strategies for the treatment of hypertension in patients with established diabetic nephropathy.