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Update on Blood Pressure Control and Renal Outcomes in Diabetes Mellitus

  • Microvascular Complications—Nephropathy (T Isakova, Section Editor)
  • Published:
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Abstract

Diabetic nephropathy (DN) is associated with a high incidence of cardiovascular (CV) morbidity and mortality. Although relationships between hypertension and diabetic nephropathy are complex, blood pressure (BP) control is an important management strategy in the prevention of onset and progression of DN in patients with diabetes mellitus (DM). Recent guidelines recommend less stringent BP targets among patients with type 2 DM and chronic kidney disease. These recommendations are based mostly on lack of benefit in CV outcomes with a low BP target. We review the current information on efficacy of BP control in improving renal outcomes in patients with type 2 DM. Presently, although intensive BP control has been was beneficial in decreasing albuminuria, it has not translated into reductions in risks of hard renal endpoints, such as progression to end-stage renal disease, the need for renal replacement therapy, and mortality from renal causes.

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Abbreviations

AACE:

American Association of Clinical Endocrinologists

ADVANCE:

Action in Diabetes and Vascular Disease: Preterax and Diamicron MR-Controlled Evaluation

ACCORD:

Action to Control Cardiovascular Risk in Diabetes

ADA:

American Diabetes Association

ACCF:

American College of Cardiology Foundation

AHA:

American Heart Association

ASH:

American Society of Hypertension

CHEP:

Canadian Hypertension Education Program

ESH:

European Society of Hypertension

ESC:

European Society of Cardiology

ISH:

International Society of Hypertension

JNC:

Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

KDIGO:

Kidney Disease Improving Global Outcomes

NHANES:

National Health and the Nutrition Examination Survey

NICE:

National Institute for Health and Care Excellence

NKF KDOQI:

National Kidney Foundation Kidney Disease Outcomes Quality Initiative

ONTARGET:

Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial

USRDS:

US Renal Data System

VADT:

Veterans Affairs Diabetes Trial

VA NEPHRON-D:

Veterans Affairs Nephropathy in Diabetes

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Mark Henry Joven declares he has no conflict of interest. Robert J. Anderson discloses clinical trial funds from Merck, Astra Zeneca, Bristol-Myers Squibb, and Boehringer Ingelheim.

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  1. Endocrinology, Diabetes and Metabolism, Creighton University, 601 N. 30th Street, Suite 5766, Omaha, NE, 68131, USA

    Mark Henry Joven & Robert J. Anderson

  2. Endocrinology, Diabetes, and Metabolism, VA-Nebraska Western Iowa Healthcare System, 4101 Woolworth Ave. Res 151, Omaha, NE, 68105, USA

    Mark Henry Joven & Robert J. Anderson

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This article is part of the Topical Collection on Microvascular Complications—Nephropathy

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Joven, M.H., Anderson, R.J. Update on Blood Pressure Control and Renal Outcomes in Diabetes Mellitus. Curr Diab Rep 15, 44 (2015). https://doi.org/10.1007/s11892-015-0613-6

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