Management of hypertension and renin-angiotensin-aldosterone system blockade in adults with diabetic kidney disease: Association of British Clinical Diabetologists and the Renal Association UK guideline update 2021

BMC Nephrology

D. Fogarty¹  P. De²  P. Winocour³  S. Zac-Varghese³  J. Karalliedde⁴  A. H. Frankel⁵  R. Montero⁶  D. C. Patel⁷  T. A. Chowdhury⁸  D. Banerjee⁹  M. Wahba^1,10  S. Bain^1,11  I. Dasgupta^1,12  A. Sharif^1,12  P. B. Mark^1,13  A. Pokrajac^1,14 

[1] Belfast Health and Social Care Trust, Belfast, UK;City Hospital, Birmingham, UK;ENHIDE, East and North Herts NHS Trust, Stevenage, UK;Guy’s and St Thomas’ Hospital London, London, UK;Imperial College Healthcare NHS Trust, London, UK;King’s College, London, UK;Royal Free London NHS Foundation Trust, London, UK;Royal London Hospital, London, UK;St George’s Hospitals NHS Foundation Trust, London, UK;St Helier Hospital, Carshalton, UK;Swansea University, Swansea, UK;University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;University of Glasgow, Glasgow, UK;West Hertfordshire Hospitals, London, UK;

关键词: Diabetes;    Hypertension;    Chronic kidney disease;    dialysis;    ACE inhibitors;    Angiotensin receptor blockers;   

DOI  :  10.1186/s12882-021-02587-5

来源: Springer

【 摘 要 】

People with type 1 and type 2 diabetes are at risk of developing progressive chronic kidney disease (CKD) and end-stage kidney failure. Hypertension is a major, reversible risk factor in people with diabetes for development of albuminuria, impaired kidney function, end-stage kidney disease and cardiovascular disease. Blood pressure control has been shown to be beneficial in people with diabetes in slowing progression of kidney disease and reducing cardiovascular events. However, randomised controlled trial evidence differs in type 1 and type 2 diabetes and different stages of CKD in terms of target blood pressure. Activation of the renin-angiotensin-aldosterone system (RAAS) is an important mechanism for the development and progression of CKD and cardiovascular disease. Randomised trials demonstrate that RAAS blockade is effective in preventing/ slowing progression of CKD and reducing cardiovascular events in people with type 1 and type 2 diabetes, albeit differently according to the stage of CKD. Emerging therapy with sodium glucose cotransporter-2 (SGLT-2) inhibitors, non-steroidal selective mineralocorticoid antagonists and endothelin-A receptor antagonists have been shown in randomised trials to lower blood pressure and further reduce the risk of progression of CKD and cardiovascular disease in people with type 2 diabetes. This guideline reviews the current evidence and makes recommendations about blood pressure control and the use of RAAS-blocking agents in different stages of CKD in people with both type 1 and type 2 diabetes.

【 授权许可】

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