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Your Blood Pressure
The possible role of blood pressure (BP) reduction in treatment of diabetic kidney disease initially was shown by Scandinavian researchers. In 1990s United Kingdom Microalbumin Study exploring the effect of improved glycemic control unexpectedly found that a mean BP (above 93.6 mm Hg) rather than glycated hemoglobin predicts progression from macroalbuminuria to macro albuminuria in patients with T1DM. The UKPDS BP-trial in T2DM revealed that a reduction in BP from 154/87 mm Hg to 144/82 mm Hg over 9 years of follow-up led to decrease in the risk of 24% for any diabetesrelated end point; 32% for diabetes-related death and 29% reduction in risk of microalbuminuria. In comparison; intensive blood glucose control in the United Kingdom Prospective Diabetes Study decreased the risk of any diabetes related end point only by 12% (Figure 1). Thus; sustained management of BP appears to be more important than glycemic control in reducing cardiovascular events; cardiovascular mortality and slowing diabetic renal disease progression.
The prevalence of hypertension in diabetes is approximately twofold that in the nondiabetic population. With the onset of overt diabetic nephropathy; clear-cut hypertension is common in both types of diabetes mellitus; however; about 30% of patients with T2DM are already hypertensive at the time of diagnosis of diabetes .Therefore; it is very important to evaluate the efficacy of antihypertensive therapy in preventing diabetic complications and slowing progression of diabetic kidney disease; as well as; determining optimal BP targets in patients with diabetes. Considering the renoprotective benefits from the ACEIs in treatment of diabetic nephropathy; the particular advantages of one class of drugs over another should also be established. The first large interventional trial conducted to address these issues was Appropriate Blood Pressure Control in Diabetes (ABCD) trial.
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