Natural history of hypertension and kidney disease in diabetes

Diabetic nephropathy is the most severe complication of insulin-dependent diabetes mellitus. Epidemiological studies have shown that 30-40% of the patients develop this complication, which is associated with an increase in mortality. Haemodynamic factors, in particular, hyperfiltration, increased flow, and capillary hypertension have been suggested to be of pathogenetic importance, but this is still controversial. Of clinical importance is the close association between clinical diabetic nephropathy and increased blood pressure. Several studies have demonstrated a beneficial effect of early antihypertensive therapy. Most encouraging, however, is the recent finding of a reduced mortality in patients with diabetic nephropathy in whom early antihypertensive therapy has been carried out.