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Antihypertensive therapy in diabetes
1Division of Renal Diseases, University of Minnesota, Minneapolis 55455.
Insights
Approximately one third of patients with insulin-dependent diabetes mellitus (IDDM) develop end-stage renal disease. Controlling high blood pressure is crucial for slowing diabetic nephropathy progression.
Area of Science:
- Nephrology
- Endocrinology
- Cardiovascular Medicine
Background:
- Insulin-dependent diabetes mellitus (IDDM) is a leading cause of end-stage renal disease.
- Early stages of IDDM may involve elevated glomerular filtration rates (GFR), plasma flow, and capillary pressure.
- Arterial hypertension exacerbates renal vasodilation, potentially leading to glomerular injury in diabetic patients.
Purpose of the Study:
- To investigate the impact of arterial hypertension on diabetic nephropathy progression.
- To evaluate the efficacy of antihypertensive control in managing diabetic nephropathy.
- To determine optimal blood pressure targets for patients with diabetic nephropathy.
Main Methods:
- Observational analysis of patients with IDDM and varying degrees of renal involvement.
- Assessment of GFR, plasma flow rates, and capillary pressure.
- Evaluation of antihypertensive treatment strategies and their effect on disease progression.
Main Results:
- A significant percentage of IDDM patients develop end-stage renal disease.
- Elevated renal hemodynamics and hypertension are associated with increased risk of glomerular injury.
- Effective antihypertensive control significantly reduces the rate of diabetic nephropathy progression.
Conclusions:
- Tight blood pressure control, targeting mean arterial pressures below 100 mmHg, is essential for managing diabetic nephropathy.
- Both standard and specific antihypertensive agents can slow disease progression.
- Early intervention and management of hypertension are critical in preserving renal function in IDDM patients.
Abstract:
Approximately one third of patients with IDDM develop end-stage renal disease. About the same percentage, though not of certainty the same patients, have elevated GFRs and plasma flow rates early in their disease and probably have elevated capillary pressure. Arterial hypertension in the setting of this pattern of renal vasodilation may be particularly predisposing to glomerular injury. Treatment of established diabetic nephropathy with good antihypertensive control can dramatically reduce the rate of progression of the disease. However, blood pressure control should be targeted to near normal ranges, that is, mean arterial pressures less than 100 mmHg and preferably lower. Some agents may be particularly beneficial in slowing the progression of the disease, but even standard agents have very important effects.