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The Goal of Blood Pressure Control for Prevention of Early Diabetic Microvascular Complications

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Abstract

Lowering blood pressure may confer a benefit to diabetic microvascular complications comparable with glycemic control. Hypertension is causally related to kidney outcomes and is a risk factor for the development of diabetic retinopathy. The prevalence of hypertension increases as kidney disease progresses, so that it coexists with diabetes in up to 80% of those with overt nephropathy. A significant number of patients have hypertension or rising blood pressures in earlier stages, or even before microvascular complications appear. Because microalbuminuria markedly increases the risk of overt nephropathy as well as of cardiovascular complications, primary prevention (i.e., preventing or delaying the onset of microalbuminuria) continues to be explored, predominantly through use of renin-angiotensin blockade. Available data reviewed suggest that primary prevention through blood pressure reduction is more likely to benefit select groups (those with hypertension, cardiovascular risks, or old age). This review discusses the relationship between hypertension, diabetes, and kidney disease, the rationale for primary prevention, and the data that led to that conclusion.

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Abbreviations

ACCORD:

Action to Control Cardiovascular Risk in Diabetes

BENEDICT:

Bergamo Nephrologic Diabetes Complication Trial

DIRECT:

Diabetic Retinopathy Candesartan Trials

EUCLID:

EURODIAB Controlled Trial of Lisinopril in Insulin-Dependent Diabetes

KDOQI:

Kidney Disease Outcomes Quality Initiative

NHANES III:

Third National Health and Nutrition Examination Survey

RASS:

Renin Angiotensin System Study

ROADMAP:

Randomized Olmesartan and Diabetes Microalbuminuria Prevention

UKPDS:

United Kingdom Prospective Diabetes Study

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  1. Renal Unit, Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215, USA

    Mark E. Williams

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Williams, M.E. The Goal of Blood Pressure Control for Prevention of Early Diabetic Microvascular Complications. Curr Diab Rep 11, 323–329 (2011). https://doi.org/10.1007/s11892-011-0193-z

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