Retarding the progression of diabetic nephropathy in type 2 diabetes mellitus: focus on hypertension and proteinuria.

INTRODUCTION: There is a worldwide pandemic of type 2 diabetes mellitus and approximately one-third of these individuals will develop diabetic nephropathy. Coupled with their increased risk for cardiovascular disease, these individuals pose an enormous economic and social burden to all countries. This review will discuss therapeutic strategies, aimed at control of blood pressure and proteinuria, to prevent or retard the development of diabetic nephropathy.

METHODS: Studies that involved patients with type 2 diabetes with albuminuria (microalbuminuria or proteinuria) and/or hypertension and/or renal impairment were included in this review. The PubMed Medline database was used as the source of data.

RESULTS: Blood pressure control is paramount in reducing cardiovascular risk and the development of diabetic nephropathy. The target blood pressure is <130/80 mm Hg in all patients with type 2 diabetes. Angiotensin receptor blockers (ARBs) are the preferred first-line agents while angiotensin-converting enzyme (ACE) inhibitors can be considered in those with microalbuminuria and normoalbuminuria. Reduction in proteinuria retards the progression of nephropathy and should be considered as a goal on its own. Dual therapy with an ACE inhibitor and ARB can be considered in patients with severe proteinuria or uncontrolled hypertension.

CONCLUSION: Important strategies to prevent or retard the progression of diabetic nephropathy in type 2 diabetes include excellent blood pressure control with an aggressive approach to reduce microalbuminuria or proteinuria. The drugs of choice are the ARB and the ACE inhibitor.