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Published on: May 26, 2022

Treating hypertension in diabetic nephropathy

Jeremy W Tomlinson1, Katharine R Owen, Colin F Close

  • 1Department of Diabetes, Taunton and Somerset Hospital, Taunton, UK.

Diabetes Care
|May 27, 2003
PubMed

Insights

A stepped-care algorithm using ACE inhibitors or ARBs was used to manage hypertension in diabetic nephropathy patients. While similar to clinical trial results, achieving target blood pressure, especially systolic, remained challenging for most patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Endocrinology

Background:

  • Hypertension control in diabetic nephropathy is crucial for improving mortality and slowing kidney disease progression.
  • Managing blood pressure in these patients is complex, often necessitating combination drug therapy.
  • Established treatment algorithms for hypertension in diabetic nephropathy are lacking.

Purpose of the Study:

  • To evaluate a stepped-care algorithm for hypertension management in patients with diabetic nephropathy.
  • To assess the achievement of American Diabetes Association blood pressure targets (<130/80 mmHg) using this algorithm.
  • To determine the efficacy of ACE inhibitor or ARB-centered therapy in this patient group.

Main Methods:

  • A prospective study involving 49 patients with diabetes (type 1 and type 2) and diabetic nephropathy.
  • Patients received treatment via a stepped-care algorithm, prioritizing maximum doses of ACE inhibitors or ARBs.
  • Blood pressure control was assessed at follow-up, with a median duration of 18 months.

Main Results:

  • Mean blood pressure achieved was 140/75 mmHg for type 1 and 146/76 mmHg for type 2 diabetes.
  • Only 33% of patients reached the target blood pressure goal.
  • Systolic blood pressure remained above target in the majority of patients, irrespective of baseline characteristics.

Conclusions:

  • A stepped-care algorithm can achieve blood pressure control comparable to clinical trials in diabetic nephropathy.
  • Despite aggressive multi-drug therapy, achieving target systolic blood pressure remains a significant challenge in this population.
  • Further strategies may be needed to optimize hypertension management in patients with diabetic nephropathy.
Abstract

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