Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes

Schrier, Robert W.; Estacio, Raymond O.; Esler, Anne; Mehler, Philip S.

doi:10.1046/j.1523-1755.2002.00213.x

Cited by 748 publications

(497 citation statements)

References 35 publications

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“…9 Even in normotensive diabetic patients, lowering blood pressure can be beneficial in controlling diabetic nephropathy and retinopathy. 10 In particular, in patients with type 2 DM, the risk of diabetic nephropathy and retinopathy was independently and additively attributable to hypertension and hyperglycemia. 6 Arterial hypertension is a main risk factor in the development and progression of diabetic nephropathy, 9 and a sustained reduction in blood pressure is probably the most effective single intervention to slow the progression of nephropathy in type 1 and type 2 DM.…”

Section: Clinical and Epidemiological Evidence Of The Detrimental Effmentioning

confidence: 99%

“…6 Arterial hypertension is a main risk factor in the development and progression of diabetic nephropathy, 9 and a sustained reduction in blood pressure is probably the most effective single intervention to slow the progression of nephropathy in type 1 and type 2 DM. 7,[9][10][11] In the Wisconsin Epidemiology Study of DR, the presence of hypertension in type 1 diabetic patients was associated with a 73% increase in the risk of incident proliferative DR. 12 More recently, the Wisconsin Epidemiology Study of DR demonstrated that the 25-year incidence of visual impairment was related to poorer glycemia control and the presence of arterial hypertension. In these patients, the presence of arterial hypertension increases the risk of visual impairment by 72%.…”

Section: Clinical and Epidemiological Evidence Of The Detrimental Effmentioning

confidence: 99%

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The contribution of hypertension to diabetic nephropathy and retinopathy: the role of inflammation and oxidative stress

2011

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Diabetes and hypertension frequently coexist and constitute the most notorious combination for the pathogenesis of diabetic nephropathy and retinopathy. Large clinical trials have clearly demonstrated that tight control of glycemia and/or blood pressure significantly reduces the incidence and progression of diabetic retinopathy (DR) and nephropathy. However, the mechanism by which hypertension interacts with diabetes to induce and/or exacerbate nephropathy and retinopathy is very unclear. Substantial evidence implicates the involvement of chronic inflammation and oxidative stress in the pathogenesis of DR and nephropathy. In addition, hypertension causes oxidative stress and inflammation in the kidney and retina. In the present review, we summarized data obtained from our research along with those from other groups to better understand the role of hypertension in the pathogenesis of diabetic nephropathy and retinopathy. It is suggested that oxidative stress and inflammation may be common denominators of kidney and retinal damage in the concomitant presence of diabetes and hypertension.

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Section: Clinical and Epidemiological Evidence Of The Detrimental Effmentioning

confidence: 99%

Section: Clinical and Epidemiological Evidence Of The Detrimental Effmentioning

confidence: 99%

The contribution of hypertension to diabetic nephropathy and retinopathy: the role of inflammation and oxidative stress

2011

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“…34,40,[46][47][48][56][57][58][59] Clinical trials, grouped by the degree of albuminuria, demonstrating the beneficial effects of RAAS inhibition on renal end points in patients with diabetes mellitus are summarized in Table 2. 34,40,42,48,49,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71] Normoalbuminuria The Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) is the only primary prevention study to date to demonstrate that the development of microalbuminuria can be prevented by the use of an ACE inhibitor alone or in combination with a CCB in hypertensive normoalbuminuric patients with type II diabetes. 59 …”

Section: Clinical Evidence Of Benefits Of Raas Inhibition In Patientsmentioning

confidence: 99%

“…In type II diabetes, several studies have demonstrated that ARBs and ACE inhibitors can reduce the progression of microalbuminuria, and some of these trials will be discussed in more detail later in this article. 40,58,63 Macroalbuminuria In patients with type I diabetes and proteinuria, captopril reduced the risk of progression of nephropathy by 48% vs placebo; the risk reduction was greater in patients with higher baseline serum creatinine levels. 48 Captopril also halved the risk of the combined end point of death, dialysis, or transplantation in these patients.…”

Section: Microalbuminuriamentioning

confidence: 99%

Evidence for renoprotection by blockade of the renin–angiotensin–aldosterone system in hypertension and diabetes

Karalliedde

Viberti

2006

J Hum Hypertens

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The incidence of end-stage renal disease (ESRD) is rising worldwide, accompanied by corresponding increases in the risk of morbidity and mortality. Underlying this trend are increasing rates of hypertension and diabetes mellitus, the two most common causes of ESRD. In addition to the adverse haemodynamic effects of hypertension on the kidney, elevated blood pressure (BP) can activate components of the renin-angiotensinaldosterone system (RAAS), which, in turn, activate mediators of inflammation, oxidative stress, cell growth, and matrix accumulation. Lowering BP reduces the risk of cardiovascular events and renal damage. Accumulating evidence from clinical and laboratory studies suggests that interrupting the RAAS with therapies such as angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and aldosterone receptor blockers can interfere with the mechanisms that promote diabetic and non-diabetic renal damage. Moreover, clinical trials of RAAS blockade have demonstrated reductions in microalbuminuria, a predictor of increased cardiorenal risk and overt nephropathy in patients with and without diabetes and/or hypertension. In this way, agents that block the RAAS should be considered the drugs of first choice as they provide enhanced renoprotection compared with other classes of antihypertensive agents such as calcium channel blockers and b-blockers.

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“…Normotensive patients with advanced DN show slower progression compared with hypertensive patients. [33][34][35][36][37][38][39][40][41][42] Non-pharmacologic approaches (dietary modifications especially and increased physical activity) are effective in reducing BP in non-diabetic individuals 43 and may have similar benefits for diabetic patients. However, pharmacologic approaches remain the mainstay for controlling BP in patients with DM.…”

Section: Blood Pressure Controlmentioning

confidence: 99%

Therapeutic Modalities in Diabetic Nephropathy: Standard and Emerging Approaches

et al. 2011

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Diabetes mellitus is the leading cause of end stage renal disease and is responsible for more than 40% of all cases in the United States. Current therapy directed at delaying the progression of diabetic nephropathy includes intensive glycemic and optimal blood pressure control, proteinuria/albuminuria reduction, interruption of the renin-angiotensin-aldosterone system through the use of angiotensin converting enzyme inhibitors and angiotensin type-1 receptor blockers, along with dietary modification and cholesterol lowering agents. However, the renal protection provided by these therapeutic modalities is incomplete. More effective approaches are urgently needed. This review highlights the available standard therapeutic approaches to manage progressive diabetic nephropathy, including markers for early diagnosis of diabetic nephropathy. Furthermore, we will discuss emerging strategies such as PPAR-gamma agonists, Endothelin blockers, vitamin D activation and inflammation modulation. Finally, we will summarize the recommendations of these interventions for the primary care practitioner.

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Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes

Cited by 748 publications

References 35 publications

The contribution of hypertension to diabetic nephropathy and retinopathy: the role of inflammation and oxidative stress

The contribution of hypertension to diabetic nephropathy and retinopathy: the role of inflammation and oxidative stress

Evidence for renoprotection by blockade of the renin–angiotensin–aldosterone system in hypertension and diabetes

Therapeutic Modalities in Diabetic Nephropathy: Standard and Emerging Approaches

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