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Retarding the progression of diabetic nephropathy in type 2 diabetes mellitus: focus on hypertension and proteinuria.
Ann Acad Med Singapore 2005; 34(1):24-30AA

Abstract

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.

Authors+Show Affiliations

Department of Renal Medicine, Singapore General Hospital, Singapore.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

15726216

Citation

Lee, G S L.. "Retarding the Progression of Diabetic Nephropathy in Type 2 Diabetes Mellitus: Focus On Hypertension and Proteinuria." Annals of the Academy of Medicine, Singapore, vol. 34, no. 1, 2005, pp. 24-30.
Lee GS. Retarding the progression of diabetic nephropathy in type 2 diabetes mellitus: focus on hypertension and proteinuria. Ann Acad Med Singap. 2005;34(1):24-30.
Lee, G. S. (2005). Retarding the progression of diabetic nephropathy in type 2 diabetes mellitus: focus on hypertension and proteinuria. Annals of the Academy of Medicine, Singapore, 34(1), pp. 24-30.
Lee GS. Retarding the Progression of Diabetic Nephropathy in Type 2 Diabetes Mellitus: Focus On Hypertension and Proteinuria. Ann Acad Med Singap. 2005;34(1):24-30. PubMed PMID: 15726216.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Retarding the progression of diabetic nephropathy in type 2 diabetes mellitus: focus on hypertension and proteinuria. A1 - Lee,G S L, PY - 2005/2/24/pubmed PY - 2005/6/10/medline PY - 2005/2/24/entrez SP - 24 EP - 30 JF - Annals of the Academy of Medicine, Singapore JO - Ann. Acad. Med. Singap. VL - 34 IS - 1 N2 - 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. SN - 0304-4602 UR - https://www.unboundmedicine.com/medline/citation/15726216/Retarding_the_progression_of_diabetic_nephropathy_in_type_2_diabetes_mellitus:_focus_on_hypertension_and_proteinuria_ L2 - http://www.annals.edu.sg/pdf200502/GLee.pdf DB - PRIME DP - Unbound Medicine ER -