Br Med J (Clin Res Ed)  1982;285:685-688 (11 September), doi:10.1136/bmj.285.6343.685

Long-term antihypertensive treatment inhibiting progression of diabetic nephropathy

Six men aged 26-35 years with proteinuria due to insulindependent juvenile-onset diabetes were treated for moderate hypertension (mean blood pressure 162/103 mm Hg) and studied for a mean of 73 months for the effect on the progression of nephropathy. All patients were of normal weight. During a mean control period of 28 months before treatment the mean glomerular filtration rate (three or four measurements) was 86·1 ml/min and mean 24-hour urinary albumin excretion (also three or four measurements) 3·9 g (range 0·5-8·8 g).

During antihypertensive treatment the mean systolic blood pressure fell to 144 mm Hg and mean diastolic pressure to 95 mm Hg. In the control period five patients had shown a mean monthly decline in glomerular filtration rate of 1·23 ml/min; with antihypertensive treatment, however, this decline fell to 0·49 ml/min (2p=0·042). In the remaining patient the glomerular filtration rate was 137 ml/min before treatment and 135 ml/min at the end of the treatment period. In all patients the mean yearly increase in albumin clearance (expressed as a percentage of the glomerular filtration rate) fell from 107% before treatment to 5% during treatment (2p=0·0099).

This small study indicates that antihypertensive treatment slows the decline in renal function in diabetic nephropathy. Clinical trials beginning treatment in the incipient phase of diabetic nephropathy will define the optimal modality of treatment in this large patient population.

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• Simpson, S. H., Corabian, P., Jacobs, P., Johnson, J. A. (2003). The cost of major comorbidity in people with diabetes mellitus. CMAJ 168: 1661-1667 [Abstract] [Full text]  
• Cameron, J S. (2003). Fifty years of established diabetic nephropathy -- a personal perspective. British Journal of Diabetes & Vascular Disease 3: 8-16  
• Poulsen, L. (2002). Blood pressure and cardiac autonomic function in relation to risk factors and treatment perspectives in Type 1 diabetes. Journal of Renin-Angiotensin-Aldosterone System 3: 222-242 [Abstract]  
• Mogensen, C. E. (2000). ACE inhibitors and antihypertensive treatment in diabetes: focus on microalbuminuria and macrovascular disease. Journal of Renin-Angiotensin-Aldosterone System 1: 234-239  
• Klein, R., Klein, B. E. K., Lee, K. E., Cruickshanks, K. J., Moss, S. E. (1996). The Incidence of Hypertension in Insulin-Dependent Diabetes. Arch Intern Med 156: 622-627 [Abstract]  
• Ravid, M., Lang, R., Rachmani, R., Lishner, M. (1996). Long-term Renoprotective Effect of Angiotensin-converting Enzyme Inhibition in Non--insulin-dependent Diabetes Mellitus: A 7-Year Follow-up Study. Arch Intern Med 156: 286-289 [Abstract]  
• Henry, R. R., Genuth, S. (1996). Forum One: Current Recommendations about Intensification of Metabolic Control in Non-Insulin-dependent Diabetes Mellitus. ANN INTERN MED 124: 175-177 [Abstract] [Full text]  
• Lewis, E. J. (1995). Captopril and Diabetic Nephropathy. JAMA 273: 1831-1831 [Abstract]  
• Maki, D. D., Ma, J. Z., Louis, T. A., Kasiske, B. L. (1995). Long-term Effects of Antihypertensive Agents on Proteinuria and Renal Function. Arch Intern Med 155: 1073-1080 [Abstract]  
• (1994). Treating hypertension in patients with diabetes mellitus. DTB 32: 79-80 [Abstract] [Full text]  
• Carella, M. J., Gossain, V. V., Rovner, D. R. (1994). Early Diabetic Nephropathy: Emerging Treatment Options. Arch Intern Med 154: 625-630 [Abstract]  
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• Gansevoort, R. T., Apperloo, A. J., Heeg, J. E., de Jong, P. E., de Zeeuw, D. (1992). The Antiproteinuric Effect of Antihypertensive Agents in Diabetic Nephropathy. Arch Intern Med 152: 2137-2138 [Abstract]  
• Parving, H.-H. (1992). Excess Mortality Associated With Diuretic Therapy in Diabetes Mellitus. Arch Intern Med 152: 1093-1094 [Abstract]  
• Rosansky, S. J., Hoover, D. R., King, L., Gibson, J. (1990). The Association of Blood Pressure Levels and Change in Renal Function in Hypertensive and Nonhypertensive Subjects. Arch Intern Med 150: 2073-2076 [Abstract]  
• Cook, J. J., Daneman, D. (1990). Microalbuminuria in Adolescents With Insulin-Dependent Diabetes Mellitus. Arch Pediatr Adolesc Med 144: 234-237 [Abstract]  
• Reddi, A. S., Camerini-Davalos, R. A. (1990). Diabetic Nephropathy: An Update. Arch Intern Med 150: 31-43 [Abstract]  
• Teuscher, A., Egger, M., Herman, J. B. (1989). Diabetes and Hypertension: Blood Pressure in Clinical Diabetic Patients and a Control Population. Arch Intern Med 149: 1942-1945 [Abstract]  
• Noth, R. H., Krolewski, A. S., Kaysen, G. A., Meyer, T. W., Schambelan, M. (1989). Diabetic Nephropathy: Hemodynamic Basis and Implications for Disease Management. ANN INTERN MED 110: 795-813 [Abstract]  
• Abraham, P. A., Opsahl, J. A., Halstenson, C. E., Keane, W. F. (1988). Efficacy and Renal Effects of Enalapril Therapy for Hypertensive Patients With Chronic Renal Insufficiency. Arch Intern Med 148: 2358-2362 [Abstract]  

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