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Antihypertensive therapy in diabetes.

T H Hostetter1

  • 1Division of Renal Diseases, University of Minnesota, Minneapolis 55455.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|June 1, 1989
PubMed
Summary

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.

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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.

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