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Antihypertensive treatment inhibiting the progression of diabetic nephropathy
Abstract:
In 6 male insulin-dependent proteinuric long-term diabetics aged 26-35 years the rate of progression of nephropathy was followed for an initial control period of 2.0 years and subsequently for 4.1 years during antihypertensive therapy with a beta-receptor blocker combined with Hydralazine and Furosemide. GFR and urinary albumin excretion was measured 3-4 times before and 9-14 times during treatment. Systolic blood pressure was reduced significantly from 162 +/- 14 (SD) mm Hg before treatment to 146 +/- 9 (SD) as a mean during the whole treatment period (2p = 0.002). Diastolic pressure was also reduced significantly, from 103 +/- 9 (SD) mm Hg to 95 +/- 8 (SD), (2p = 0.025). After 49 days of treatment there was a significant fall in albumin clearance as a per cent of GFR from 0.243 +/- 0.28 (SD) to 0.170 +/- 0.20 (SD), (2p < 0.001 for percentage change) with no change in GFR. In five patients the fall rate of GFR was in the initial control period 1.24 ml/min/month +/- 0.8 (SD). In the period when antihypertensive therapy was given it was reduced to 0.45 ml/min/month +/- 0.5 (SD) (2p = 0.037). In the 6th patient there was no decline in GFR neither before, nor during treatment. Before treatment there was a mean yearly percentage increase in albumin excretion of 107 per cent. During treatment this yearly increase was reduced to--7 per cent (2p = 0.002 for differences in slope). The results indicate that the state of renal insufficiency in diabetic patients with nephropathy and moderately increased blood pressure can be postponed by antihypertensive treatment. Other trials should be carried out to define the optimal scheme of treatment.
Insights
Antihypertensive therapy significantly reduced blood pressure and slowed kidney function decline in diabetic patients with nephropathy. This treatment may postpone the progression of renal insufficiency in this patient group.
Area of Science:
- Nephrology
- Diabetology
- Pharmacology
Background:
- Diabetic nephropathy is a major complication of diabetes mellitus.
- Proteinuria and declining glomerular filtration rate (GFR) are key indicators of nephropathy progression.
- Managing hypertension is crucial in diabetic patients to prevent cardiovascular and renal complications.
Purpose of the Study:
- To evaluate the effect of antihypertensive therapy on the progression of nephropathy in male insulin-dependent diabetics.
- To assess the impact of a specific drug combination (beta-blocker, Hydralazine, Furosemide) on GFR and albuminuria.
Main Methods:
- Longitudinal study of 6 male diabetic patients with nephropathy over 6.1 years (2.0 years control, 4.1 years treatment).
- Regular measurements of GFR and urinary albumin excretion before and during antihypertensive treatment.
- Statistical analysis of blood pressure, GFR, and albumin excretion changes.
Main Results:
- Significant reduction in systolic (162 to 146 mmHg) and diastolic (103 to 95 mmHg) blood pressure during treatment.
- Significant decrease in albumin clearance relative to GFR (0.243 to 0.170) after 49 days.
- Reduced rate of GFR decline from 1.24 to 0.45 ml/min/month during antihypertensive therapy (p=0.037).
- Yearly increase in albumin excretion reduced from 107% to -7% (p=0.002).
Conclusions:
- Antihypertensive treatment, including a beta-blocker, Hydralazine, and Furosemide, can significantly slow the progression of diabetic nephropathy.
- This therapeutic approach may postpone the onset or worsening of renal insufficiency in diabetic patients with hypertension.
- Further trials are needed to determine optimal antihypertensive regimens for diabetic nephropathy.