Treatment of hypertension in diabetic patients with nephropathy.

R. Komers, Sharon Anderson

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

In type 1 diabetes, hypertension is closely linked to the development of nephropathy. An association of hypertension and the impact of hypertension on the clinical course of type 2 diabetes, including the development of vascular complications, has been well established. However, the association with nephropathy in type 2 diabetes is less clear. Despite that, antihypertensive treatment has a crucial impact on the course of nephropathy in both types of diabetes. In this article, we discuss recent evidence focusing on the nephroprotective potential of various classes of antihypertensive agents and confront it with current recommendations for the treatment of hypertension in diabetic patients with nephropathy. Unlike type 1 diabetes, where the nephroprotection could be a good sole measure for assessing the efficiency of a particular agent or their combination, defining of the optimal antihypertensive agent or agents in type 2 diabetes requires consideration of both cardiovascular, cerebrovascular, and nephroprotective potentials of such a treatment. In both types of diabetes, recent data support the use of inhibitors of the renin-angiotensin system with or without diuretics as the initial therapy. In type 1 diabetes, additional beneficial effect can be expected from calcium channel blockers (CCBs). In type 2 diabetic patients, combining more agents may be necessary early in the course of nephropathy to affect both micro- and macrovascular targets. beta blockers should be applied early to enhance cardioprotectivity, followed by CCBs to achieve goal blood pressure. Although not supported by all recent data, aggressive blood pressure control (<130/75 mm Hg) is warranted. Furthermore, multifactorial intervention targeting metabolic derangements and lifestyle, is a necessary complimentary measure that must accompany antihypertensive treatment.

Original languageEnglish (US)
Pages (from-to)251-260
Number of pages10
JournalCurr Diab Rep
Volume1
Issue number3
StatePublished - Dec 2001

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Antihypertensive Agents
Hypertension
Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Calcium Channel Blockers
Blood Pressure
Therapeutics
Renin-Angiotensin System
Diuretics
Blood Vessels
Life Style

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Cardiology and Cardiovascular Medicine

Cite this

Treatment of hypertension in diabetic patients with nephropathy. / Komers, R.; Anderson, Sharon.

In: Curr Diab Rep, Vol. 1, No. 3, 12.2001, p. 251-260.

Research output: Contribution to journalArticle

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