Clinical Trials in Overt Diabetic Nephropathy
There is accumulating data available regarding how overt diabetic nephropathy should be treated to arrest the progressive decline in renalfunction. Some interventions are controversial but improved metabolic control is getting increasing acceptance as a way to improve prognosis also during this stage. There is agreement on that antihypertensive treatment should be aggressive and metaanalyses indicate that ACE-inhibitors offers an advantage. In non-diabetic renal disease intensive antihypertensive treatment adds only little benefit. In contrast to this, several studies have shown that aggressive antihypertensive treatment is probably the most important factor to determine the rate of decline in kidney function in diabetic nephropathy. There are no controlled studies with different target blood pressure in different groups such as in non diabetic renal disease . The evidence that antihypertensive treatment can preserve renal function comes from studies showing a much reduced rate of renal disease progression after effective blood pressure control [2,3]. These studies compare the rate of decline in glomerular filtration rate during intervention with retrospective data which is not ideal since uncontrolled factors might influence the outcome. However, the effect of antihypertensive treatment is so profound that anyone that treats these patients observe that end-stage renal failure is postponed by antihypertensive treatment and that the disease runs an accelerated course during uncontrolled hypertension.
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