Antihypertensive Treatment in Diabetic Kidney Disease: The Need for a Patient-Centered Approach

Medicina (Kaunas). 2019 Jul 16;55(7):382. doi: 10.3390/medicina55070382.

Abstract

Diabetic kidney disease affects up to forty percent of patients with diabetes during their lifespan. Prevention and treatment of diabetic kidney disease is currently based on optimal glucose and blood pressure control. Renin-angiotensin aldosterone inhibitors are considered the mainstay treatment for hypertension in diabetic patients, especially in the presence of albuminuria. Whether strict blood pressure reduction entails a favorable renal outcome also in non-albuminuric patients is at present unclear. Results of several clinical trials suggest that an overly aggressive blood pressure reduction, especially in the context of profound pharmacologic inhibition of the renin-angiotensin-aldosterone system may result in a paradoxical worsening of renal function. On the basis of this evidence, it is proposed that blood pressure reduction should be tailored in each individual patient according to renal phenotype.

Keywords: RAAS inhibitors; SGLT-2 inhibitors; blood pressure target; cardiovascular outcome; diabetes; renal outcome.

Publication types

  • Review

MeSH terms

  • Antihypertensive Agents / pharmacology
  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure / drug effects
  • Diabetes Complications / drug therapy
  • Diabetes Complications / etiology
  • Diabetes Complications / physiopathology
  • Diabetic Nephropathies / drug therapy*
  • Diabetic Nephropathies / physiopathology
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / physiopathology

Substances

  • Antihypertensive Agents