Blood Pressure Control and Nephroprotection in Diabetes

Abstract

Achievement of recommended levels of blood pressure as prescribed by guidelines (i.e., systolic blood pressure of < 130 mmHg in people with nephropathy secondary to type 2 diabetes) generally requires three or more different antihypertensive agents that have complementary modes of action. This systolic goal blood pressure, recommended by generally all international guideline committees, was derived from largely observational studies demonstrating a greater reduction of cardiovascular risk and preservation of kidney function at these levels. Commonly used antihypertensive combinations include angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers, which have compelling indications for use in people with kidney disease and/or diabetes, combined with a diuretic, generally a thiazide-type agent. If additional therapy is required, either a beta-blocker or a calcium antagonist may be added to this antihypertensive "cocktail." Beta-blockers are particularly effective in people with a high sympathetic drive (i.e., high pulse rates) to lower blood pressure and reduce cardiovascular risk. Moreover, in recent studies, their benefits on kidney function, both by reducing macroalbuminuria and slowing the decline of kidney function, make them good agents to add in the appropriate clinical setting. With all these potential benefits of achieving blood pressure goals, it is unfortunate that only 11% of people being treated for hypertension with diabetic kidney disease achieve the blood pressure goal of < 130 mmHg, likely contributing to the climbing incidence of people starting dialysis. Physicians need to work harder and educate patients on the importance of achieving these lower blood pressure guidelines.

Prompt Reduction in Use of Medications for Comorbid Conditions After Bariatric Surgery

“…There were smaller decreases in the use of medications that we did not expect to be responsive to the surgery. Patients without diabetes had a greater reduction in their use of antihypertensive medications than patients with diabetes, which could be due to physicians' more aggressive treatment of hypertension in patients with diabetes for nephroprotection or for prevention of cardiovascular complications [12]. Our use of a comparison group strengthens the evidence that the changes observed were causally related to the surgery rather than to secular changes or due to how pharmacy claims were recorded or our method for counting medications.…”

Control of Hypertension in Patients with Hypertension, Diabetes, and Impaired Fasting Glucose by Czech Primary Care Physicians

“…140 mm Hg in not more than 60-70% of the patients, while diastolic BP normalization was reported in 1 90% of the patients. According to Abbott et al [14] , systolic BP values ! 130 mm Hg are achieved in only 11% of the treated hypertensive DM patients.…”

“…130 mm Hg are achieved in only 11% of the treated hypertensive DM patients. The inadequate control of hypertension also contributes to the progression of diabetic nephropathy [14] .…”

“…Achieving systolic BP values ! 130 mm Hg in DM patients usually requires a combination of three or more antihypertensive drugs [14,17] . Combination treatment should include an angiotensin-converting enzyme inhibitor or an angiotensin-1 receptor blocker together with a thiazide diuretic.…”

Efficacy and safety of aliskiren in Japanese hypertensive patients with renal dysfunction

“…Achieving target blood pressure is of utmost importance for improving renal outcomes, as reduction in blood pressure is known to exert a nephroprotective effect. 3,15,16 In these patients with renal dysfunction, mean trough plasma aliskiren concentrations increased with dose and reached steady state 2-4 weeks after the start of dosing or up-titration of the dose. The results from an earlier study assessing the effects of renal impairment on pharmacokinetics of aliskiren (300 mg once daily) in patients with mild-to-moderate renal dysfunction and healthy volunteers showed that although exposure is increased by renal impairment, the increase in exposure does not correlate with the severity of renal impairment.…”