Blood pressure, hypertension, RAAS blockade, and drug therapy in diabetic kidney disease.
Type 2 diabetes is the most common cause of CKD and ESRD in the United States and the Western world. Hypertension is prevalent in this cohort, and control of blood pressure is perhaps the most important risk factor to reduce CKD progression. The most recent blood pressure target recommended by the Kidney Disease: Improving Global Outcomes and Kidney Disease Outcomes Quality Initiative guideline committees is less than 140/90 mmHg for all patients with CKD. There is some evidence for those with 1 g or more of albuminuria, albeit weak, to support a blood pressure target of less than 130/80 mmHg. Multiple studies demonstrate that renin-angiotensin-aldosterone system (RAAS) blockers are important in reducing cardiovascular risk and progression of CKD in those with advanced proteinuric nephropathy. However, there is no evidence that they prevent nephropathy or that reduction in microalbuminuria alone is associated with slowed nephropathy progression. The purpose of this article is to review the major studies that have evaluated cardiovascular and kidney endpoints in patients with diabetes and the role of RAAS blockers in the treatment of this disease.
Department of Medicine, American Society of Hypertension Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL.
Hala
H
Yamout
Department of Medicine, American Society of Hypertension Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL.
Ivana
I
Lazich
Department of Medicine, American Society of Hypertension Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL. Electronic address: gbakris@gmail.com.
George L
GL
Bakris
D000419:Albuminuria / Q000188:drug therapy* / Q000503:physiopathology; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D006977:Hypertension, Renal / Q000188:drug therapy* / Q000503:physiopathology; D012084:Renin-Angiotensin System / Q000187:drug effects* / Q000502:physiology
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors
Diabetes; Hypertension; Kidney; Nephropathy