Can we further slow down the progression to end-stage renal disease in diabetic hypertensive patients?

Hypertension and diabetes Hypertension occurs about twice as frequently in diabetics compared with the general population, with a prevalence of approximately 25% in young patients with insulin-dependent diabetes mellitus (IDDM) and 50% in newly diagnosed non-IDDM (NIDDM) patients. Studies strongly suggest that hypertension is involved in the progression and perhaps the onset of diabetic nephropathy, which is a major cause of illness and premature death in diabetic patients, largely through accompanying cardiovascular disease and end-stage renal failure. Treatment A large body of evidence has accumulated which emphasizes the beneficial effects of antihypertensive treatment in reducing proteinuria and preserving renal function in both IDDM and NIDDM. It appears that angiotensin converting enzyme inhibitors and certain calcium antagonists, notably the non-dihydropyridine type and second-generation dihydropyridine calcium antagonists, produce a more beneficial effect on nephropathy in terms of reducing proteinuria and slowing progression to renal failure. These drugs have displayed a nephroprotective capacity beyond their systemic blood pressure-lowering effects, and initial clinical trials with combinations of different antihypertensive drug classes have revealed additive effects in reducing albuminuria together with the lowest rate of decline in glomerular filtration rates with the lowest incidence of adverse effects. Available studies The studies available on antihypertensive treatment in IDDM and NIDDM patients with incipient or overt diabetic nephropathy are mainly prospective, There have also been some preliminary trials with antihypertensive combinations in diabetic patients.