Management of Hypertension in Diabetic Nephropathy: How Low Should We Go?

Blood Purification
Hillel Sternlicht, George L Bakris

Abstract

Hypertension is a frequent comorbidity often following the development of diabetic nephropathy among individuals with type 1 diabetes and affecting most patients with type 2 diabetes at the time of diagnosis. Multiple prospective randomized placebo-controlled trials demonstrate that tight blood pressure control among patients with diabetic nephropathy reduces the rates of macrovascular and microvascular complications. While randomized trials exist and support a blood pressure goal of <140/90 mm Hg for patients with nondiabetic kidney disease, there are no prospective data regarding a specific blood pressure goal on progression of diabetic nephropathy. Retrospective data analyses from trials show a linear relationship between either baseline or achieved study blood pressure and progression of nephropathy. Very high albuminuria is a hallmark of diabetic nephropathy with reductions by either angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blocker (ARB) monotherapy associated with slowed nephropathy progression. However, combination antihypertensive therapy, while decreasing proteinuria, augments the risk of hyperkalemia, hypotension, and kidney dysfunction. Given the lack of trial data for a BP goal among p...Continue Reading

Citations

Oct 19, 2016·Current Opinion in Nephrology and Hypertension·Omar Al Dhaybi, George Bakris
Nov 20, 2020·Biomedicine & Pharmacotherapy = Biomédecine & Pharmacothérapie·Mengjie KongDewei Ye
Nov 19, 2021·Diabetes & Vascular Disease Research : Official Journal of the International Society of Diabetes and Vascular Disease·Sopida Thipsawat

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