Improving antihypertensive therapy in patients with diabetic nephropathy
Mende, C.W.
Southern Medical Journal 99(2): 150-7; Quiz 158 167
2006
ISSN/ISBN: 0038-4348 PMID: 16509553 Document Number: 598244
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 antilrypertensive 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 antibypertensive agents to achieve these objectives. Appropriate antihypertensive therapy in patients with diabetic nephropathy delays progression of renal disease and leads to substantial cost savings.