Evolving therapeutic strategies for retarding progression of diabetic nephropathy--an update for 2002

Area of Science:

• Nephrology
• Cardiology
• Endocrinology

Background:

• Diabetic nephropathy is a major complication of diabetes, leading to progressive renal disease.
• Renin-angiotensin system (RAS) blockade has shown efficacy in slowing renal disease progression.
• Landmark trials like IDNT and RENAAL highlight the importance of RAS inhibitors.

Purpose of the Study:

• To review the role of antihypertensive agents in managing diabetic nephropathy.
• To assess the necessity of aggressive blood pressure control in diabetic patients with hypertension.
• To evaluate the potential role of calcium antagonists in combination therapy.

Main Methods:

• Review of major intervention trials on antihypertensive agents in diabetic nephropathy.
• Analysis of data from landmark trials such as IDNT and RENAAL.
• Evaluation of evidence supporting combination antihypertensive therapy.

Main Results:

• RAS blockade with ACE inhibitors or AT1 receptor antagonists is the preferred initial therapy.
• Aggressive blood pressure targets are crucial for patients with diabetes and hypertension.
• Multiple-drug regimens are frequently required to achieve target blood pressure.
• Calcium antagonists may be beneficial as add-on therapy to RAS inhibitors.

Conclusions:

• RAS blockade is fundamental in managing diabetic nephropathy.
• Achieving strict blood pressure control necessitates combination therapy.
• Calcium antagonists represent a valuable option for intensifying antihypertensive treatment in this patient population.