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Hypertension in diabetic patients: an update of interventional studies to preserve renal function
D D Hoelscher1, M R Weir, G L Bakris
1Rush University Hypertension Research Center, Department of Preventive Medicine, Rush/Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612.
Abstract:
Hypertension and diabetes mellitus are a malignant combination of diseases for the kidney. They markedly increase the risk for progressive renal injury and are the largest single cause of renal failure. Strategies to reduce the risk for renal injury in hypertensive diabetics are very important. Although Type I and Type II diabetes are different diseases, they may be associated with similar mechanisms of renal injury in hypertensive patients. Reduction of elevated systemic arterial pressure is of proven benefit in limiting progressive renal injury in diabetic hypertensives. However, converting enzyme inhibitors and possibly the nondihydropyridine calcium antagonists may possess antiproteinuric abilities independent of blood pressure reduction which, in addition to their antihypertensive effects, may be important in limiting the progression of human diabetic renal disease. Long-term clinical trials have evaluated the impact of these and other agents on progression of diabetic renal disease. This paper reviews these trials and focuses on renal effects of antihypertensive agents independent of blood pressure reduction.
Insights
Hypertension and diabetes mellitus significantly harm kidneys, leading to renal failure. Certain antihypertensive drugs may protect kidneys beyond just lowering blood pressure, crucial for managing diabetic kidney disease.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Hypertension and diabetes mellitus are leading causes of kidney disease and renal failure.
- These conditions accelerate progressive renal injury, especially in combination.
- Understanding renal injury mechanisms in hypertensive diabetics is critical.
Purpose of the Study:
- To review clinical trials on antihypertensive agents in diabetic renal disease.
- To focus on renal effects independent of blood pressure reduction.
- To identify strategies limiting renal injury in hypertensive diabetics.
Main Methods:
- Review of long-term clinical trials.
- Analysis of antihypertensive agents' impact on diabetic renal disease progression.
- Evaluation of renal effects beyond blood pressure lowering.
Main Results:
- Elevated blood pressure reduction benefits hypertensive diabetics' kidneys.
- Converting enzyme inhibitors and some calcium antagonists show antiproteinuric effects.
- These effects may be independent of blood pressure reduction.
Conclusions:
- Antihypertensive agents can limit diabetic renal disease progression.
- Renal protection may occur through mechanisms beyond blood pressure control.
- Further research into specific drug classes is warranted for kidney protection.