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Rational drug treatment of the hypertensive diabetic with nephropathy
1Department of Internal Medicine, Ruperto-Carola-University, Heidelberg, Germany.
Abstract:
Development of hypertension in Type I diabetics parallels evolution of nephropathy. In Type II diabetics, excessive prevalence of hypertension prior to the appearance of proteinuria suggests that factors other than nephropathy are operative in its pathogenesis. On the other hand, the risk of nephropathy in Type II diabetics is higher than previously appreciated. Recent evidence suggests that angiotensin II plays an important role in the induction and progression of diabetic nephropathy. This provides a rationale for antihypertensive therapy with converting enzyme inhibitors in nephropathic diabetics in whom they have been shown to lower blood pressure and diminish proteinuria. Furthermore, in a retrospective study of patients with various renal diseases (including diabetic nephropathy), the authors found suggestive evidence that converting enzyme inhibitors may also attenuate progression of renal failure to a greater extent than other antihypertensive drugs.
Insights
Hypertension in Type II diabetes may stem from factors beyond kidney disease. Converting enzyme inhibitors show promise in managing blood pressure and slowing kidney failure progression in diabetics.
Area of Science:
- Nephrology
- Endocrinology
- Cardiology
Background:
- Hypertension is common in Type I diabetics, linked to nephropathy.
- In Type II diabetes, hypertension often precedes proteinuria, suggesting other causes.
- The risk of nephropathy in Type II diabetes is significant.
Purpose of the Study:
- To investigate the role of angiotensin II in diabetic nephropathy.
- To evaluate the efficacy of converting enzyme inhibitors in managing hypertension and proteinuria in diabetics.
- To assess the impact of converting enzyme inhibitors on the progression of renal failure.
Main Methods:
- Review of existing evidence on hypertension and nephropathy in diabetes.
- Analysis of studies on angiotensin II's role in diabetic nephropathy.
- Examination of clinical trials and retrospective studies on converting enzyme inhibitors.
Main Results:
- Angiotensin II is implicated in the development and progression of diabetic nephropathy.
- Converting enzyme inhibitors effectively lower blood pressure and reduce proteinuria in nephropathic diabetics.
- Retrospective data suggest converting enzyme inhibitors may slow renal failure progression more than other antihypertensives.
Conclusions:
- Converting enzyme inhibitors are a rational therapeutic choice for hypertensive, nephropathic diabetics.
- Further research is warranted to confirm the renoprotective effects of converting enzyme inhibitors in diabetic nephropathy and other renal diseases.