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Diabetic hypertensive patients: improving their prognosis
1Rush University Hypertension Center, Rush Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
Insights
Controlling blood glucose and blood pressure is crucial for diabetic patients to prevent kidney disease and cardiovascular issues. Angiotensin-converting enzyme (ACE) inhibitors and specific calcium-channel blockers can help preserve renal function in hypertensive diabetics.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Diabetes mellitus presents significant vascular complications.
- Hypertension exacerbates diabetic progression to end-stage renal disease and cardiovascular events.
- Blood glucose and blood pressure control are key predictors of renal outcomes in diabetic patients.
Purpose of the Study:
- To review the role of antihypertensive medications in preserving renal function in diabetic patients.
- To emphasize the importance of blood pressure control in managing diabetic nephropathy.
- To discuss the potential benefits of fixed-dose combinations for medication compliance.
Main Methods:
- Review of recent studies on antihypertensive medications in diabetic patients.
- Analysis of data on the impact of blood pressure levels on renal function.
- Evaluation of specific drug classes, including ACE inhibitors and calcium-channel blockers.
Main Results:
- Angiotensin-converting enzyme (ACE) inhibitors are effective initial agents for blood pressure control in hypertensive diabetics.
- Nondihydropyridine calcium-channel blockers slow renal function decline in non-insulin-dependent diabetes mellitus (NIDDM) nephropathy.
- Blood pressure reduction to <130/85 mm Hg retards diabetic renal disease progression.
Conclusions:
- Achieving low blood pressure targets is paramount for preserving renal function in diabetic patients.
- Medication choice is secondary to achieving target blood pressure levels.
- Fixed-dose combinations of antihypertensive agents may improve goal achievement and patient compliance.
Abstract:
Diabetes is a devastating disease with multiple adverse effects on the vasculature. Moreover, hypertension is a prerequisite for patients with diabetes to progress to end-stage renal disease and to develop cardiovascular complications. Adequate control of blood glucose and blood pressure are the two most important factors that predict a favorable renal outcome. Recent studies have also shown that some classes of antihypertensive medications, such as the angiotensin-converting enzyme (ACE) inhibitors, may be ideal initial agents to control blood pressure in the hypertensive diabetic patient and thus to preserve renal function. In addition, nondihydropyridine calcium-channel blockers have been shown to retard the decline in renal function in patients with non-insulin-dependent diabetes mellitus (NIDDM) nephropathy who have lost at least 50% of their renal function. Retrospective analyses demonstrate that a reduction in blood pressure, especially to levels of <130/85 mg Hg in diabetic patients, retards the progression of renal disease. Reduction in arterial pressure to these low levels is probably more important than the agents used to achieve this goal. Because many of these patients require more than one medication to achieve these lower levels of arterial pressure, it is clear that fixed-dose combinations of such agents will both improve the likelihood of achieving a given blood pressure goal as well as medication compliance.