Progression of diabetic nephropathy. A focus on arterial pressure level and methods of reduction

It is well accepted that a reduction of arterial pressure to levels of less than 140/90 mmHg will slow the decline in renal function among patients with diabetic nephropathy. More recently it is appreciated that the reduction of arterial pressure to levels much below 130/85 mmHg provides even greater levels of protection against the progression of renal disease. Given that the achievement of blood pressure reduction to such a level requires more than one medication and that the patient's compliance is best with a once-daily medication, it makes sense to combine antihypertensive medications so as to maximize the benefit. In this way, fixed dose combination medications yield synergistic effects on blood pressure reduction while providing, in some cases, maximal benefit to preservation of renal function. Such a combination is the verapamil/trandolapril combination. This paper discusses in great detail the advantages of blood pressure reduction and the types of medications that may achieve both protection against diabetic nephropathy progression as well as blood pressure reduction.