Improving antihypertensive therapy in patients with diabetic nephropathy
Abstract
Nearly all patients with diabetic nephropathy have comorbid hypertension, which greatly elevates the risk for cardiovascular events. As patients are surviving longer, their risk of progressing to end-stage renal disease is increasing, particularly in patients with type 2 diabetes. Prevention of cardiovascular and renal events in this population requires diligent efforts to control blood pressure, serum glucose, and serum lipids. Improving antihypertensive therapy in patients with diabetic nephropathy relies on the following unified strategies: reducing blood pressure to <130/80 mm Hg, prescribing an agent that blocks the renin-angiotensin system, and designing an antihypertensive regimen that both reduces albuminuria and provides cardiovascular protection. A majority of patients will require three or more antihypertensive agents to achieve these objectives. Appropriate antihypertensive therapy in patients with diabetic nephropathy delays progression of renal disease and leads to substantial cost savings.
References
The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes
Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy
Effect of PPAR-gamma activation and inhibition on glucose-stimulated insulin release in INS-1e cells
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