Nephrology Dialysis Transplantation, Vol 13, Issue 90008 44-48, Copyright © 1998 by Oxford University Press
R Nosadini, C Abaterusso, M Vestra, E Bortoloso, A Saller, M Bruseghin, A Sfriso and M Trevisan
The mechanism underlying the pathogenesis of microangiopathy and
macroangiopathy in diabetes mellitus is hypothesized to be chronic
hyperglycaemia. However, the values of blood glucose at which chronic
diabetic complications develop at the renal and cardiac level are quite
different. It is not clear whether this is due to different responses of
kidney and heart tissues to the metabolic challenge of diabetes, or to the
simultaneous role of other mechanisms contributing differently to the
pathogenesis of chronic diabetic complications in renal and cardiac
tissues. One of these mechanism could be the simultaneous occurrence of
arterial hypertension along with hyperglycaemia in diabetic patients.We
reviewed the available evidence in the recent medical literature and
provide information on the relationships between hyperglycaemia and
cardiovascular and renal complications in insulin-dependent diabetes
mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). The
majority of reports indicate that the values of blood glucose appearing to
be at threshold level for the development of cardiovascular complications
are significantly lower than those determining renal complications (5.4
vs 10.0 mmol/l blood glucose concentrations 2 h afer
an oral glucose tolerance test). This was the case both in cross-sectional
and prospective studies and also in intervention studies aimed at
decreasing blood glucose concentrations by using strict metabolic methods
(The Diabetes Control and Complications Trial Research Group), which
succeeded in delaying the rate of occurrence of microangiopathic
complications at the kidney and retinal level but not so effectively at the
cardiac level. Therefore, alternative therapeutic or supplementary
strategies to blood glucose control should be adopted in diabetes to
prevent diabetic complications. To date, the most effective approach, from
our point of view, is antihypertensive therapy in order to prevent
end-stage renal disease. We extensively reviewed the available literature
which reported comparisons between angiotensin-converting enzyme inhibitors
(ACE inhibitors) and calcium channel blockers (CCBs) in the treatment of
arterial hypertension in diabetes. Intensified antihypertensive therapy
achieving a blood pressure level below 130/85 mmHg has been shown to be
useful in decreasing the rate of occurrence of chronic diabetic
complications in diabetes mellitus. Both ACE inhibitors and CCBs hae been
shown to significantly improve the course of renal function in diabetic
patients with incipient and overt nephropathy.Key
words: angiotensin-converting enzyme inhibitors; calcium channel
blockers; cardiovascular complications; diabetes mellitus; diabetic
nephropathy
ORIGINAL ARTICLES
Efficacy of antihypertensive therapy in decreasing renal and cardiovascular complications in diabetes mellitus
Department of Internal Medicine and National Research Centre for the Study of Ageing, University of Padova, Italy; Corresponding author at: Clinica Medica, Università di Sassari, Viale San Pietro, 8, 79100 Sassari, Italy
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