Hypertension in Diabetics with Renal Disease

  • Eberhard Ritz
  • Christoph Hasslacher
  • Johannes Mann
Part of the Topics in Renal Medicine book series (TIRM, volume 6)


Ever since the demonstration of high prevalence of hypertension in diabetics by Hitzenberger in 1921 [1], hypertension has been recognized as a major complication of diabetes. However, for a long time, it had remained the Cinderella of diabetology. Only recently, the mechanisms involved in the genesis of hypertension have been studied, its influence on progression of nephropathy has been recognized, and the necessity of rigorous blood pressure control both prior to renal failure and in advanced renal failure has been widely appreciated.


Diabetic Patient Diabetic Nephropathy Calcium Antagonist Antihypertensive Treatment Urinary Albumin Excretion Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hitzenberger K: Über den Blutdruck bei Diabetes mellitus. Wien Arch Inn Med 2: 461, 1921.Google Scholar
  2. 2.
    Hasslacher Ch, Rambausek M, Ritz E: Genesis and management of hypertension of diabetic nephropathy. In: Keen H, Legrain M (eds) prevention and treatment of diabetic nephropathy. MTP Press Limited, 1983, pp 177–189.Google Scholar
  3. 3.
    Weidmann P: Recent pathogenetic aspects in essential hypertension and hypertension associated with diabetes mellitus. Klin Wochenschr 58: 1071, 1980.PubMedCrossRefGoogle Scholar
  4. 4.
    O’Hare JA, Ferriss JB, Brady D, Twomey B, O’Sullivan DJ: Exchangeable sodium and renin in hypertensive diabetic patients with and without nephropathy. Hypertension [Suppl 2] 7: 43–48, 1985.CrossRefGoogle Scholar
  5. 5.
    O’Hare JP, Roland JM, Walters G, Corrall RJM: Impaired sodium excretion in response to volume expansion induced by water immersion in non-insulin-dependent diabetes mellitus. Clin Sci 71: 403–409, 1986.PubMedGoogle Scholar
  6. 6.
    Sawicki P, Heinemann L, Rave K, Hohmann A, Tilwix F, Berger M: Erhöhte a-ANP Konzentrationen bei Hypertonen Typ-I-Diabetikern, Abhängigkeit vom Grad der Nephropathie. Hochdruck 8:32(a), 1986 [10. Wissenschaftliche Tagung Dtsch. Ges. zur Bekämpfung des Hohen Blutdrucks, Münster, November 1986 ].Google Scholar
  7. 7.
    De Chatel R, Toth M, Barna I, Büki B, Lang RE: Differential responses in atrial natriuretic peptide and urinary sodium excretion following an intravenous saline load in normal man and in patients with diabetes mellitus. Hochdruck 8:31(a), 1986 [ibid].Google Scholar
  8. 8.
    Walter-Schräder M-C, Jungmann E, Haak T, Rosak C, Schwab N, Fassbinder W, Althoff PH, Schöffling K: Verminderte natriuretische Wirksamkeit des humanen atrialen natriuretischen Peptides (hANP) bei Patienten mit Typ I Diabetes mellitus. Hochdruck 8:31(a), 1986 [ibid].Google Scholar
  9. 9.
    Drury PL, Smith GM, Ferriss JB: Increased vascular responsiveness to angiotensin II in type I (insulin-dependent) diabetic patients without complications. Diabetologia 27: 174–179, 1984.PubMedGoogle Scholar
  10. 10.
    Christlieb AR, Kaldany A, D’Elia JA, Williams GE: Aldosterone responsiveness in patients with diabetes mellitus. Diabetes 27: 732–737, 1978.PubMedCrossRefGoogle Scholar
  11. 11.
    Tornita K, Matsuda O, Ideura T, Shiigai T, Takeuchi J: Renin—angiotensin—aldosterone system in mild diabetic nephropathy. Nephron 31: 361–367, 1982.CrossRefGoogle Scholar
  12. 12.
    Wilson TW, Tan LK: Low plasma renin activity in diabetes: relation to urine prostaglandin excretion. Diabetes 34: 145–150, 1985.PubMedCrossRefGoogle Scholar
  13. 13.
    Luetscher JA, Kraemer FB, Wilson DM, Schwartz HC, Bryer-Ash M: Increased plasma inactive renin in diabetes mellitus. N Engl J Med 312: 1412–1417, 1985.PubMedCrossRefGoogle Scholar
  14. 14.
    Drury PL, Bodansky HJ, Oddie CJ, Cudworth AG, Edwards CRW: Increased plasma renin activity in type 1 diabetes with microvascular disease. Clin Endocrinol 16: 453, 1982.CrossRefGoogle Scholar
  15. 15.
    Ferriss JB, O’Hare JA, Cole M, Kingston SM, Twomey BM, O’Sullivan DJ: Blood pressure in diabetic patients: relationship with exchangeable sodium and renin activity. Diabetic Nephropathy 5: 27–30, 1986.Google Scholar
  16. 16.
    Walker WG, Hermann J, Murphy R, Patz A: Elevated blood pressure and angiotensin are associated with accelerated loss of renal function in diabetic nephropathy. In: Fourth Int Nutr Metab Renal Disease, Williamsburg, 1985, 80a.Google Scholar
  17. 17.
    Björck S, Delin K, Herlitz H, Larson O, Aurell M: Renin secretion in advanced diabetic nephropathy. Scand J Urol Nephrol 79: S53, 1984.Google Scholar
  18. 18.
    Ballermann BJ, Skorecki KL, Brenner BM: Reduced glomerular angiotensin II receptor density in early untreated diabetes mellitus in the rat. Am J Physiol 247: F110 — F116, 1984.PubMedGoogle Scholar
  19. 19.
    Heidbreder E, Götz R, Schafferhans K, Heidland A: Diminished parathyroid gland responsiveness to hypocalcemia in diabetic patients with uremia. Nephron 42: 285–289, 1986.PubMedCrossRefGoogle Scholar
  20. 20.
    Hasslacher Ch, Stech W, Wahl P, Ritz E: Blood pressure and metabolic control as risk factors for nephropathy in type 1 (insulin-dependent) diabetes. Diabetologia 28: 6–11, 1985.PubMedCrossRefGoogle Scholar
  21. 21.
    Hasslacher Ch, Ritz E, Terpstra J, Gallasch G, Kunowski G, Rall C: Natural history of nephropathy in type I diabetes: relationship to metabolic control and blood pressure. Hypertension [Supp 2] 7:11–74–11–78, 1985.Google Scholar
  22. 22.
    Mogensen CE, Christensen CK: Blood pressure changes and renal function in incipient and overt diabetic nephropathy. Hypertension [Suppl 2] 7:11–64–11–73, 1985.Google Scholar
  23. 23.
    Mauer SM, Steffes MW, Ellen EN, Sutherland DER, Brown DM, Goetz FC: Structural—functional relationships in diabetic nephropathy. J Clin Invest 74: 1143–1155, 1984.PubMedCrossRefGoogle Scholar
  24. 24.
    Ritz E, Strumpf C, Katz F, Wing AJ, Quellhorst E: Hypertension and cardiovascular risk factors in hemodialyzed diabetic patients. Hypertension [Suppl 2] 7:11–118—II-124, 1985.Google Scholar
  25. 25.
    Strumpf C, Katz F, Wing AJ, Ritz E: Cardiovascular risk factors and cardiovascular death in hemodialyzed diabetic patients. Proc Eur Dial Transplant Assoc 21: 202–208, 1984.Google Scholar
  26. 26.
    Chou LM, Beyer MM, Butt KM, Manis T, Friedman EA: Hypertension jeopardizes diabetic patients following renal transplant. Trans Am Soc Artif Intern Organs 30: 473–478, 1984.PubMedGoogle Scholar
  27. 27.
    Casale PN, Devereux RB, Milner M, Zullo G, Harshfield GA, Pickering TG, Laragh JH: Value of echocardiographic measurement of left ventricular mass in predicting cardiovascular morbid events in hypertensive men. Ann Intern Med 105: 173–178, 1986.PubMedGoogle Scholar
  28. 28.
    Munichoodappa D, D’Elia JA, Libertino JA, Gleason RE, Christlieb AR: Renal artery stenosis in hypertensive diabetics. J Urol 121: 555, 1978.Google Scholar
  29. 29.
    Chihara J, Takebayashi S, Taguchi T, Yokoyama K, Harada T, Naito S: Glomerulonephritis in diabetic patients and its effect on the prognosis. Nephron 43: 45–49, 1986.PubMedCrossRefGoogle Scholar
  30. 30.
    Zatz R, Dunn BR, Meyer TW, Anderson S, Rennke HG, Brenner BM: Prevention of diabetic glomerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 77: 1925–1930, 1986.PubMedCrossRefGoogle Scholar
  31. 31.
    Anderson S, Meyer TW, Rennke HG, Brenner BM: Control of glomerular hypertension limits glomerular injury in rats with reduced renal mass. J Clin Invest 76: 612–619, 1985.PubMedCrossRefGoogle Scholar
  32. 32.
    Ritz E, Hasslacher Ch: Genesis and treatment of hypertension in diabetes mellitus. Diabetic Nephropathy 3: 2, 1984.Google Scholar
  33. 33.
    Sato T, Nara Y, Note S, Yamori Y: Unproved glucose metabolism in hypertensive diabetic rats by antihypertensive treatment. In: 11th Scient Meet Int Soc Hypert, Heidelberg, August 1986, 0492a.Google Scholar
  34. 34.
    Topol EJ, Traili TA, Fortuin NJ: Hypertensive hypertrophie cardiomyopathy of the elderly. N Engl J Med 312:277-, 1985.Google Scholar
  35. 35.
    Massry SG, Feinstein EI, Goldstein DA: Early dialysis in diabetic patients with chronic renal failure. Nephron 23: 2–5, 1979.PubMedCrossRefGoogle Scholar
  36. 36.
    Mathiesen ER, Hommel E, Kastrup J, Parving HH: The effect of acute arterial blood pressure reduction on kidney function in incipient and overt diabetic nephropathy. Diabetic Nephropathy 5: 45, 1986.Google Scholar
  37. 36.
    Cavallo T, Pinto JA, Rajaraman S: Immune complex disease complicating diabetic glomerulosclerosis. Am J Nephrol 4: 347–354, 1984.PubMedCrossRefGoogle Scholar
  38. 37.
    Knowler WC, Bennett PH, Ballintine EJ: Increased incidence of retinopathy in diabetics with elevated blood pressure. N Engl J Med 302: 645–650, 1980.PubMedCrossRefGoogle Scholar
  39. 38.
    Baldwin DS: Chronic gomerulonephritis: non-immunologic mechanisms of progressive glomerular damage. Kidney Int 21: 109–120, 1982.PubMedCrossRefGoogle Scholar
  40. 38.
    Christensen CK, Mogensen CE: Effect of antihypertensive treatment on progression of incipient diabetic nephropathy. Hypertension [Suppl 2] 7:11–109–11–113, 1985.Google Scholar
  41. 38.
    Christensen CK, Mogensen CE: Long-term antihypertensive treatment reduces both baseline and exercise-induced microalbuminuria in diabetics with incipient nephropathy. Diabetic Nephropathy 5: 46–47, 1986.Google Scholar
  42. 39.
    Björck S, Nyberg G, Mulec H, Granerus G, Herlitz H, Aurell M: Beneficial effects of angiotensin converting enzyme inhibition on renal function in patients with diabetic nephropathy. Br Med J 293: 471–474, 1986.CrossRefGoogle Scholar
  43. 40.
    Dominguez JR, de la Calle H, Hurtado A, Robles HG, Sancho-Rof J: Effect of captopril on metabolic control in hypertensive patients with type II diabetes. In: Captopril symposium. London: Royal Academy of Physicians, 1985, 25a.Google Scholar
  44. 41.
    Elling H, Elling H: Penicillamine, captropril and hypoglycemia. Ann Intern Med 103: 644, 1985.PubMedGoogle Scholar
  45. 42.
    Helgeland A, Hagelund CH, Strommen R, Tretli S: Enalapril, atenolol, and hydrochlorothiazide in mild to moderate hypertension. Lancet 1: 872–875, 1984.Google Scholar
  46. 43.
    Rett K, Jauch W, Wicklemeyer M, Dietze G, Mehnert H: Experimental and human experienced with ACE inhibition in diabetes: evidence for improvement in glucose metabolism. In: Captopril symposium. London: Royal Academy of Physicians, 1985, 23a.Google Scholar
  47. 44.
    Taguma Y, Kitamoto Y, Futaki G, Ueda H, Monma H, Ishiziaki M, Takahashi H, Sekino H, Sasaki Y: Effect of captopril on heavy proteinuria in azotemic diabetics. N Engl J Med 313: 1617–1620, 1985.PubMedCrossRefGoogle Scholar
  48. 45.
    Malaisse-Lagae F, Mathias PC, Malaisse WJ: Gatting and blocking of calcium channels by dishydropyridines in the pancreatic B-cell. Biochem Biophys Res Commun 123: 1062, 1984.PubMedCrossRefGoogle Scholar
  49. 46.
    Bhatnagar SK, Amin MM, Al-Yusuf AR: Diabetogenic effects of nifedipine. Br Med J 289: 19, 1984.CrossRefGoogle Scholar
  50. 47.
    Abadie E, Villette JM, Gauveille C, Tabuteau F, Fiet J: Influence of nifedipine on carbohydrate metabolism in non-insulin-dependent diabetic patients. Diabete Metab 11: 141, 1985.PubMedGoogle Scholar
  51. 48.
    Trost BN, Weidmann P: Effects of nitrendipine and other calcium antagonists on glucose metabolism in man. J Cardiovasc Pharmacol [Suppl 7] 6: 986, 1984.CrossRefGoogle Scholar
  52. 49.
    Roejdmark S, Andersson DE: Influence of verapamil on glucose tolerance. Acta Med Scand [Suppl 681] 215: 37, 1984.CrossRefGoogle Scholar
  53. 50.
    Hiedland A, Heidbreder E, Hörl WH, Schäfer R: Calcium antagonists in the treatment of hypertension. Contrib Nephrol 33: 254–269, 1982.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1988

Authors and Affiliations

  • Eberhard Ritz
  • Christoph Hasslacher
  • Johannes Mann

There are no affiliations available

Personalised recommendations