Antihypertensive treatment in diabetic kidney disease: The need for a patient-centered approach

Barbara Bonino, Giovanna Leoncini, Salvatore De Cosmo, Eulalia Greco, Giuseppina T. Russo, Annalisa Giandalia, Francesca Viazzi, Roberto Pontremoli

Research output: Contribution to journalReview articlepeer-review


Diabetic kidney disease affects up to forty percent of patients with diabetes during their lifespan. Prevention and treatment of diabetic kidney disease is currently based on optimal glucose and blood pressure control. Renin–angiotensin aldosterone inhibitors are considered the mainstay treatment for hypertension in diabetic patients, especially in the presence of albuminuria. Whether strict blood pressure reduction entails a favorable renal outcome also in non-albuminuric patients is at present unclear. Results of several clinical trials suggest that an overly aggressive blood pressure reduction, especially in the context of profound pharmacologic inhibition of the renin–angiotensin–aldosterone system may result in a paradoxical worsening of renal function. On the basis of this evidence, it is proposed that blood pressure reduction should be tailored in each individual patient according to renal phenotype.

Original languageEnglish
Article number382
JournalMedicina (Lithuania)
Issue number7
Publication statusPublished - Jan 1 2019


  • Blood pressure target
  • Cardiovascular outcome
  • Diabetes
  • RAAS inhibitors
  • Renal outcome
  • SGLT-2 inhibitors

ASJC Scopus subject areas

  • Medicine(all)


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