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Management of Hypertension in Diabetic Kidney Disease

Gates B Colbert1, Mohamed E Elrggal2, Anna Gaddy3

  • 1Division of Nephrology, Texas A&M University College of Medicine at Dallas, Dallas, TX 75246, USA.

Journal of Clinical Medicine
|November 14, 2023
PubMed

Insights

Controlling hypertension significantly delays diabetic kidney disease progression. Current treatments focus on the renin-angiotensin-aldosterone system, SGLT2 inhibitors, and MRAs, with new agents emerging for this growing patient population.

Area of Science:

  • Nephrology
  • Cardiology
  • Endocrinology

Background:

  • Hypertension accelerates cardiovascular disease and diabetic kidney disease (DKD) progression.
  • The precise relationship between hypertension and DKD progression is debated, but control is proven beneficial.
  • DKD affects a growing population, necessitating advanced treatment strategies.

Purpose of the Study:

  • To review current and emerging pharmacologic treatments for hypertension in DKD patients.
  • To highlight medications targeting the renin-angiotensin-aldosterone system (RAAS).
  • To discuss guideline-changing therapies like SGLT2 inhibitors and novel MRAs.

Main Methods:

  • Review of existing literature and clinical experience with antihypertensive medications in DKD.
  • Focus on drug classes proven effective in managing hypertension and slowing DKD progression.
  • Discussion of emerging pharmacologic agents and their potential impact.

Main Results:

  • Control of hypertension, particularly within guideline-recommended ranges, demonstrably slows DKD progression.
  • RAAS inhibitors remain a cornerstone of treatment.
  • Sodium-glucose cotransporter 2 (SGLT2) inhibitors and newer mineralocorticoid receptor antagonists (MRAs) represent significant advancements.

Conclusions:

  • Effective hypertension management is crucial for mitigating DKD progression.
  • A combination of established and novel pharmacotherapies offers improved outcomes.
  • Ongoing research into new drug classes is vital for optimizing care in this complex patient group.

Keywords:
RAASiSGTL2ialdosteronehypertensionmineralocorticoid receptor antagonist

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