Hypertension and the renal vascular complications of diabetes: a structural basis to guide management

The biochemical and structural alterations responsible for the renal and vascular complications of diabetes mellitus are likely to be the result of common processes. It is now well recognized that microalbuminuria is a powerful predictor of cardiovascular morbidity and mortality in diabetic patients. Increased cell growth and vascular tone and insulin resistance are among the contributors that lead to the renal and vascular complications of diabetes. Angiotensin-converting enzyme inhibitors, which may decrease the negative impact of these contributors, are effective therapeutic agents that reduce the risk of progression of renal disease and early mortality.