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The pathogenesis and management of hypertension in diabetic kidney disease

Peter N Van Buren1, Robert D Toto

  • 1Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-8516, USA. Peter.vanburen@utsouthwestern.edu

The Medical Clinics of North America
|January 8, 2013
PubMed

Insights

Hypertension management is crucial for patients with diabetes and kidney disease. Effective blood pressure control, using agents like ACE inhibitors or ARBs, is key to slowing disease progression and preventing end-stage renal disease (ESRD).

Area of Science:

  • Nephrology
  • Endocrinology
  • Cardiovascular Medicine

Background:

  • Hypertension frequently coexists with diabetes, particularly in patients with diabetic kidney disease.
  • The development of hypertension in this population involves increased extracellular volume and vasoconstriction, linked to diabetes and declining renal function.
  • Controlling blood pressure is essential for preventing and managing diabetic kidney disease progression.

Purpose of the Study:

  • To review the role of antihypertensive therapy in patients with diabetes and kidney disease.
  • To discuss current therapeutic strategies, including ACE inhibitors, ARBs, and combination RAAS therapy.
  • To highlight the need for further research into optimal management to slow progression to end-stage renal disease (ESRD).

Main Methods:

  • Review of existing literature on hypertension in diabetic kidney disease.
  • Analysis of the mechanisms contributing to hypertension in this patient group.
  • Evaluation of the efficacy and risks of various antihypertensive drug classes.

Main Results:

  • ACE inhibitors or ARBs are recommended as initial therapy, titrated to maximum tolerated doses.
  • Combination RAAS therapy may reduce proteinuria but carries risks of hyperkalemia and renal function decline.
  • Endothelin receptor antagonists show potential for proteinuria reduction but lack proven long-term renal benefits and may cause fluid overload.

Conclusions:

  • Antihypertensive therapy is a cornerstone in managing diabetic kidney disease.
  • Further large-scale clinical trials are necessary to establish definitive strategies for slowing ESRD progression in this population.
  • Balancing the benefits and risks of combination therapies remains a critical clinical challenge.

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