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Blood pressure control--effects on diabetic nephropathy progression: how low does blood pressure have to be?
Christopher A Newton1, Philip Raskin
1Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, G5.238, Dallas, TX 75390-8858, USA.
Insights
Lowering blood pressure in diabetic patients significantly reduces the risk of kidney disease progression. The study suggests that the lower the blood pressure, the better the outcomes for diabetic nephropathy.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Hypertension and diabetes are independent risk factors for cardiovascular disease and renal complications.
- The coexistence of hypertension and diabetes significantly increases the risk of progression to end-stage renal disease and cardiovascular mortality.
- Current guidelines recommend lower antihypertensive therapy initiation for diabetic patients (130/85 mm Hg) compared to the general population.
Purpose of the Study:
- To review recent investigations on the effects of blood pressure on diabetic nephropathy progression.
- To evaluate the optimal blood pressure targets for patients with diabetes and hypertension to prevent renal complications.
Main Methods:
- Systematic review of recently published investigations.
- Analysis of studies examining the relationship between blood pressure levels and the progression of diabetic nephropathy.
Main Results:
- Evidence supports reducing mean arterial blood pressure to levels below 95 mm Hg.
- This target is lower than the 130/80 mm Hg (MAP 97 mm Hg) recommended by the American Diabetes Association and National Kidney Foundation.
- The effect of blood pressure on renal disease progression is linear with no apparent lower threshold for benefit.
Conclusions:
- Lowering blood pressure in diabetic patients is crucial for limiting nephropathy progression.
- The optimal blood pressure target for minimizing the effects of blood pressure on diabetic nephropathy progression is 'the lower, the better'.
Abstract:
Hypertension and diabetes are independent risk factors for both cardiovascular disease and renal complications. Coexistence of these comorbid conditions predisposes the patient to a much greater risk of progression to end-stage renal disease. Combined with the increased cardiovascular mortality, this has led to recent Joint National Committee-VI recommendations for the initiation of antihypertensive therapy for people with diabetes at a blood pressure of 130/85 mm Hg, a level lower than that recommended for the nondiabetic population. Results of a review of recently published investigations on the effects of blood pressure on diabetic nephropathy progression are presented in this article. This review finds evidence to support reducing the mean arterial blood pressure to levels below 95 mm Hg, a level that is even lower than the blood pressure of 130/80 mm Hg (mean arterial pressure of 97 mm Hg) recommended by the American Diabetes Association and National Kidney Foundation. The effect of blood pressure on renal disease progression is linear and appears to have no lower threshold for the benefits of blood pressure reduction on limiting nephropathy progression. The answer to the question of how low does blood pressure have to be to minimize the effects of blood pressure on diabetic nephropathy progression might be "the lower, the better."