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

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

Barbara Bonino  1 , Giovanna Leoncini  1 , Salvatore De Cosmo  2 , Eulalia Greco  2 , Giuseppina T Russo  3 , Annalisa Giandalia  3 , Francesca Viazzi  1 , Roberto Pontremoli  4
Affiliations
Review

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

Barbara Bonino et al. Medicina (Kaunas). .

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.

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Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Viazzi F., Russo G., Ceriello A., Fioretto P., Giorda C., De Cosmo S., Pontremoli R. Natural history and risk factors for diabetic kidney disease in patients with T2D: Lessons from the AMD-annals. J. Nephrol. 2018;32:517–525. doi: 10.1007/s40620-018-00561-3. - DOI - PubMed
    1. Holman R.R., Paul S.K., Bethel M.A., Matthews D.R., Neil H.A. 10-year follow-up of intensive glucose control in type 2 diabetes. N. Engl. J. Med. 2008;359:1577–1589. doi: 10.1056/NEJMoa0806470. - DOI - PubMed
    1. UK Prospective Diabetes Study (UKPDS) Group Intensive blood-glucose control with sulphonylureas or insulin compred with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet. 1998;352:837–853. doi: 10.1016/S0140-6736(98)07019-6. - DOI - PubMed
    1. Williams B., Mancia G., Spiering W., Agabiti Rosei E., Azizi M., Burnier M., Clement D.L., Coca A., De Simone G., Dominiczak A., et al. Authors/Task Force Members: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). ESC/ESH Guidelines for the management of arterial hypertension. J. Hypertens. 2018;36:1953–2041. doi: 10.1097/HJH.0000000000001940. - DOI - PubMed
    1. Viazzi F., Leoncini G., Grassi G., Pontremoli R. Antihypertensive treatment and renal protection: Is there a J-curve relationship? J. Clin. Hypertens. 2018;20:1560–1574. doi: 10.1111/jch.13396. - DOI - PMC - PubMed

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