The role of hypertension in diabetic nephropathy

Hypertension in diabetes mellitus has recently come under intense investigation. In type I diabetes its relation to nephropathy appears to be causal. It has been clearly demonstrated that control of hypertension retards progression of diabetic nephropathy and presumably also the occurrence of cardiovascular accidents. The relation between type II diabetes and hypertension is more complex. Hypertension may be present even in the absence of clinically overt nephropathy. This may be related to the recently postulated aetiological roles of insulin resistance and hyperinsulinaemia in blood pressure elevation. Recognition and treatment of even minor blood pressure elevation in diabetes is a challenge to the diabetologist and nephrologist alike.