Expired CME Article

Improving Antihypertensive Therapy in Patients with Diabetic Nephropathy

Authors: Christian W. Mende, MD, FACP, FACN, FASN


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 antihypertensive 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 antihypertensive agents to achieve these objectives. Appropriate antihypertensive therapy in patients with diabetic nephropathy delays progression of renal disease and leads to substantial cost savings.

Key Points

* Diabetic nephropathy is the most common cause of end-stage renal disease (ESRD).

* End-stage renal disease is very expensive to manage and any interventions that may prevent or delay the onset of ESRD in patients with diabetes would lead to major cost savings.

* Reducing the risk of renal and cardiovascular events in patients with diabetic nephropathy relies on controlling blood pressure, hyperglycemia, and dyslipidemia.

* The vast majority of patients with diabetic nephropathy have hypertension.

* All patients with diabetic nephropathy should have blood pressure controlled to levels <130/80 mm Hg, per clinical guideline recommendations.

* Regardless of blood pressure levels, agents that block the renin-angiotensin system should be the cornerstone of antihypertensive therapy in patients with diabetes.

* Most patients with diabetic nephropathy will require combination antihypertensive therapy. The antihypertensive regimen should be designed to bring the patient to blood pressure goal, reduce albuminuria, and provide cardiovascular protection.

* Treating diabetic nephropathy appropriately slows progression of renal disease and may prevent progression to renal failure, thereby prolonging life while lowering direct medical costs.

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