Effects of long-term antihypertensive treatment on kidney function in diabetic nephropathy.

Parving, Hans‐Henrik; Andersen, Andreas; Hommel, Eva; Smidt, U

doi:10.1161/01.hyp.7.6_pt_2.ii114

Cited by 48 publications

(23 citation statements)

References 17 publications

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“…Moreover, recent studies have suggested that the predisposition to hypertension, as assessed by family history or an abnormally high rate of erythrocyte sodiumlithium countertransport, may serve as an important marker of those patients who are at increased risk of developing diabetic nephropathy at a time early in the course of IDDM when renal function and blood pressure are still normal (29,30). The importance of these findings is underscored by the fact that antihypertensive therapy has been shown to retard the deterioration in renal function in diabetic nephropathy and may prove to be one of the most important interventions capable of preventing this serious complication (31,32).…”

Section: Natural History and Complicationsmentioning

confidence: 99%

Etiology and Prevalence of Hypertension in Diabetic Patients

Simonson

1988

Diabetes Care

127

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Data from several epidemiologic studies have suggested that the prevalence of hypertension in patients with diabetes mellitus is -1.5-2.0 times greater than in an appropriately matched nondiabetic population. In patients with insulin-dependent diabetes mellitus (IDDM), hypertension is generally not present at the time of diagnosis. As renal insufficiency develops, blood pressure rises and may exacerbate the progression to end-stage renal failure. In non-insulin-dependent diabetes mellitus (NIDDM), many patients are hypertensive at the time of diagnosis. The incidence of hypertension in NIDDM is related to the degree of obesity, advanced age, and extensive atherosclerosis that is typically present, and it probably includes many patients with essential hypertension. Several other pathophysiologic mechanisms also contribute to the genesis and maintenance of hypertension in the patient with diabetes. Hyperglycemia and increases in totalbody exchangeable sodium may lead to extracellular fluid accumulation and expansion of the plasma volume. In some patients, alterations in the function of the renin-angiotensin-aldosterone system and vascular sensitivity to vasoactive hormones may also play a role. It has recently been suggested that hyperinsulinemia and insulin resistance may also contribute to the maintenance of an elevated blood pressure because insulin is known to promote sodium retention and enhance sympathetic nervous system activity. The evidence for these hypotheses and their respective contributions to the etiology of hypertension in IDDM and NIDDM are discussed. Diabetes Care 11:821-27, 1988

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Section: Natural History and Complicationsmentioning

confidence: 99%

Etiology and Prevalence of Hypertension in Diabetic Patients

Simonson

1988

Diabetes Care

127

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“…Numerous studies in persons with type 1 diabetes mellitus (45)(46)(47)(48)(49) show that BP lowering, even without RAS modulator drugs, slows down the loss of kidney function. Another important consideration relates to the optimal treatment of patients with diabetic nephropathy.…”

Section: Evidence That Bp Lowering Slows the Progressive Loss Of Kidnmentioning

confidence: 99%

Prevention of Hypertension and Its Complications

Flack¹,

Peters²,

Shafi³

et al. 2003

Journal of the American Society of Nephrology

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Abstract. Hypertension is a nutritional-hygienic disease. Longterm caloric intake in excess of energy expenditures, chronic supraphysiological intake of dietary sodium, excessive alcohol consumption, and psychosocial stressors all contribute to the development of hypertension throughout the world. Elevated BP, particularly systolic BP, has been linked to multiple adverse clinical outcomes including stroke, heart failure, myocardial infarction, renal insufficiency/failure, peripheral vascular disease, retinopathy, dementia, and premature mortality. These undesirable clinical outcomes are typically, although not invariably, preceded by pressure-related target-organ injury such as left ventricular hypertrophy, renal insufficiency and proteinuria. The relation of BP and CKD and, in turn, the prevention of CKD or forestalling its progression by hypertension treatment, will be the focus of this manuscript. In hypertensive persons with reduced kidney function and/or proteinuria, lowering BP with multidrug therapy that is inclusive of pharmacologic modulators of the renin-angiotensin-aldosterone-kinin system is an effective strategy to forestall the progressive loss of kidney function. The totality of data support low therapeutic BP targets for persons with proteinuria Ͼ1 g/d.Nevertheless, in persons with CKD, even those with proteinuria below the dipstick positive level (approximately 300 mg/d or urine protein to creatinine ratio of 0.22), aggressive BP control also may be warranted because of the high risk of nonrenal cardiovascular disease. Multiple antihypertensive drugs will be required in the vast majority of patients with diabetes and/or reduced kidney function to attain BP goal. Renin-angiotensin system (RAS) modulator therapy is indicated among persons with diabetes mellitus and CKD. Available data support the use of angiotensin receptor blockers in persons with type 2 diabetes and overt nephropathy for preservation of kidney function. Among persons with type I diabetes with or without overt nephropathy, type 2 diabetes without overt nephropathy and in nondiabetic CKD, the available clinical data support the use of angiotensin-converting enzyme inhibitors as the RAS modulator of choice. Low therapeutic target BP levels Ͻ130/80 mmHg in persons with type 2 diabetes mellitus also appear warranted based on available data mostly for reducing the risk of nonrenal cardiovascular disease and overall mortality. Hypertension, like most cardiovascular conditions, is a nutritional-hygienic disease. The seeds of hypertension are rooted in physical inactivity, obesity, high caloric intake, and excessive dietary sodium intake as well as alcohol consumption. Genetic susceptibility to hypertension remains ill-defined; however, environmental exposures of gene-environment interactions can be favorably influenced by manipulation of lifestyle choices.Prevention of hypertension-related complications such as reduced kidney function depends on population-wide control of known hypertension risk factors. Population-based hypertension pr...

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“…In addition, a family history of hypertension and an elevated lithium-sodium countertransport in erythrocytes may be markers for diabetic patients with a susceptibility to develop renal disease (67). Reduction in systemic arterial pressure retards the development of renal failure and reduces proteinuria (9,10). However, all antihypertensive agents may not be equally effective in retarding renal damage in diabetes, because the reduction in systemic blood pressure may not alter intraglomerular pressure.…”

Section: Selection Of Therapymentioning

confidence: 99%

“…The incidence of cerebral vascular disease is twice as high in hypertensive as in normotensive diabetic patients (8). High blood pressure also accelerates the decline in renal function in patients with diabetic nephropathy (9,10). Epidemiologic studies have also found an association between blood pressure levels and diabetic retinopathy (11J2).…”

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confidence: 99%

Treatment of Hypertensive Diabetic Patients

Tuck¹

1988

Diabetes Care

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This article briefly reviews the literature on the incidence of hypertension in the diabetic population, the risks associated with this combination of conditions, and the nonpharmacologic and other therapies available to lower blood pressure in these patients. Although several studies of nonpharmacologic therapies and diuretics are considered, the emphasis is on the reported advantages and disadvantages of p-blockers, centrally acting agents, a-adrenergic-blocking agents, calcium-channel blockers, and angiotensin-converting enzyme inhibitors. Diabetes Care 11:828-32, 1988 A lthough the incidence of high blood pressure in the diabetic population is not precisely known, it appears to be considerably higher than that in the nondiabetic population (1-4). When adjustments are made for the effect of age, the prevalence of hypertension is relatively higher in those with type I (insulin-dependent) than in those with type II (non-insulin-dependent) diabetes (5). Coexisting hypertension and diabetes act as additive risk factors to accelerate vascular complications. The Framingham study found that the risk of cardiovascular disease is higher in diabetic patients, especially diabetic women; the impact was greatest for intermittent claudication and congestive heart failure and less noticeable in coronary artery disease. The Whitehall study, however, demonstrated that the risk for coronary artery disease is higher in hypertensive than in normotensive diabetic patients (6).

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Effects of long-term antihypertensive treatment on kidney function in diabetic nephropathy.

Cited by 48 publications

References 17 publications

Etiology and Prevalence of Hypertension in Diabetic Patients

Etiology and Prevalence of Hypertension in Diabetic Patients

Prevention of Hypertension and Its Complications

Treatment of Hypertensive Diabetic Patients

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