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

Medicina

Annalisa Giandalia¹  GiuseppinaT. Russo¹  Francesca Viazzi²  Barbara Bonino²  Giovanna Leoncini²  Roberto Pontremoli²  Eulalia Greco³  Salvatore De Cosmo³ 

[1] Department of Clinical and Experimental Medicine, University of Messina, Piazza Pugliatti 1, 98122 Messina, Italy;Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, Viale Benedetto XV 6, 16132 Genoa, Italy;IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, 71013 San Giovanni Rotondo (FG), Italy;

关键词: diabetes;    blood pressure target;    RAAS inhibitors;    SGLT-2 inhibitors;    renal outcome;    cardiovascular outcome;   

DOI  :  10.3390/medicina55070382

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown