Impact of hypertension on prognosis in IDDM

In Type I diabetes, hypertension is usually associated with the development of diabetic nephropathy. In proteinuric patients hypertension has a deleterious effect on the progression of microangiopathy and macroangiopathy, which in turn impairs their quality of life and long-term prognosis. As shown in numerous studies, hypertension accelerates loss of renal function. After kidney transplantation, the percentage of functioning grafts is much lower in diabetic patients who remain hypertensive. Furthermore, the rate of development of proliferative retinopathy, a common complication in proteinuric diabetics, increases in the presence of hypertension. Finally, hypertensive blood pressure values at the start of maintenance hemodialysis are significant predictors of cardio-vascular death among diabetics of renal replacement therapy. It has recently been demonstrated that during the last two decades blood pressure control has improved in proteinuric Type I diabetic patients. These results are associated with better renal prognosis and higher life expectancy.