title: Crucial role of kidney function in resistance to antihypertensive therapy in patients with diabetes mellitus.
abstract: OBJECTIVE
  Effective blood pressure (BP) control is difficult to achieve in diabetic patients. This study investigated factors that exacerbate resistance to antihypertensive medication in patients with diabetes.
  
  
  METHODS
  Hypertensive patients with type 2 diabetes (n = 108, 67 ± 9 years) were subjected to a step-wise upward titration of medication (step 1, routine dose of angiotensin receptor blocker; step 2, routine doses of angiotensin receptor blocker and calcium channel blocker; step 3, step 1 + double dose of calcium channel blocker; step 4, double doses of angiotensin receptor blocker and calcium channel blocker; step 5, step 4 + routine dose of diuretic; step 6, step 5 + routine dose of β-blocker; step 7, step 6 + routine dose of α-blocker; step 8, step 6 + double dose of α-blocker) implemented with a target home BP of below 130/80 mmHg. The step number at which target BP was achieved was considered the amount of antihypertensive medications needed for BP control.
  
  
  RESULTS
  All patients reached the target BP at step 4.0 ± 1.5. Multivariate regression analysis identified estimated glomerular filtration rate, but not measures of glycemic control, as an independent predictor of the number of drugs needed for BP control (P < 0.0001).
  
  
  CONCLUSIONS
  The number of antihypertensive medications needed for BP control in patients with diabetes mellitus is largely dependent on estimated glomerular filtration rate. Impaired kidney function could produce resistance to antihypertensive therapy in diabetic patients.
authors.affiliation: Department of Internal Medicine, Komono Kosei Hospital, Komono, Mie, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Kojima
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Dohi
authors.forename: Masuo
authors.initials: M
authors.lastname: Ohashi
authors.forename: Koichi
authors.initials: K
authors.lastname: Sato
authors.forename: Genjiro
authors.initials: G
authors.lastname: Kimura
mesh_terms: D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000494:pharmacology; D000959:Antihypertensive Agents / Q000494:pharmacology*; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000473:pathology; D007668:Kidney / Q000502:physiology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents