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 article

Abstract

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)
Volume55
Issue number7
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Diabetic Nephropathies
Antihypertensive Agents
Blood Pressure
Kidney
Albuminuria
Therapeutics
Aldosterone
Clinical Trials
Hypertension
Phenotype
Glucose

Keywords

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

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Antihypertensive treatment in diabetic kidney disease : The need for a patient-centered approach. / Bonino, Barbara; Leoncini, Giovanna; De Cosmo, Salvatore; Greco, Eulalia; Russo, Giuseppina T.; Giandalia, Annalisa; Viazzi, Francesca; Pontremoli, Roberto.

In: Medicina (Lithuania), Vol. 55, No. 7, 382, 01.01.2019.

Research output: Contribution to journalReview article

Bonino, B, Leoncini, G, De Cosmo, S, Greco, E, Russo, GT, Giandalia, A, Viazzi, F & Pontremoli, R 2019, 'Antihypertensive treatment in diabetic kidney disease: The need for a patient-centered approach', Medicina (Lithuania), vol. 55, no. 7, 382. https://doi.org/10.3390/medicina55070382
Bonino, Barbara ; Leoncini, Giovanna ; De Cosmo, Salvatore ; Greco, Eulalia ; Russo, Giuseppina T. ; Giandalia, Annalisa ; Viazzi, Francesca ; Pontremoli, Roberto. / Antihypertensive treatment in diabetic kidney disease : The need for a patient-centered approach. In: Medicina (Lithuania). 2019 ; Vol. 55, No. 7.
@article{30a2df97e75949fc9f503a3ac398fbdd,
title = "Antihypertensive treatment in diabetic kidney disease: The need for a patient-centered approach",
abstract = "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.",
keywords = "Blood pressure target, Cardiovascular outcome, Diabetes, RAAS inhibitors, Renal outcome, SGLT-2 inhibitors",
author = "Barbara Bonino and Giovanna Leoncini and {De Cosmo}, Salvatore and Eulalia Greco and Russo, {Giuseppina T.} and Annalisa Giandalia and Francesca Viazzi and Roberto Pontremoli",
year = "2019",
month = "1",
day = "1",
doi = "10.3390/medicina55070382",
language = "English",
volume = "55",
journal = "Medicina",
issn = "1010-660X",
publisher = "Kauno Medicinos Universitetas",
number = "7",

}

TY - JOUR

T1 - Antihypertensive treatment in diabetic kidney disease

T2 - The need for a patient-centered approach

AU - Bonino, Barbara

AU - Leoncini, Giovanna

AU - De Cosmo, Salvatore

AU - Greco, Eulalia

AU - Russo, Giuseppina T.

AU - Giandalia, Annalisa

AU - Viazzi, Francesca

AU - Pontremoli, Roberto

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Blood pressure target

KW - Cardiovascular outcome

KW - Diabetes

KW - RAAS inhibitors

KW - Renal outcome

KW - SGLT-2 inhibitors

UR - http://www.scopus.com/inward/record.url?scp=85070617050&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070617050&partnerID=8YFLogxK

U2 - 10.3390/medicina55070382

DO - 10.3390/medicina55070382

M3 - Review article

VL - 55

JO - Medicina

JF - Medicina

SN - 1010-660X

IS - 7

M1 - 382

ER -