Key result
Tailoring blood pressure targets to renal phenotype prevents paradoxical kidney decline in diabetic kidney disease.
Why the study?
Whether strict blood pressure reduction entails a favorable renal outcome in non-albuminuric patients with diabetic kidney disease is unclear.
Does strict blood pressure reduction and RAAS inhibition improve renal and cardiovascular outcomes across different phenotypes of diabetic kidney disease?
Does strict blood pressure reduction and RAAS inhibition improve renal and cardiovascular outcomes across different phenotypes of diabetic kidney disease?
Antihypertensive therapy in diabetic kidney disease must be individualized based on albuminuria status to maximize cardiovascular and renal protection while avoiding treatment-induced renal harm.
May support phenotype-tailored BP targets to avoid renal harm in diabetic kidney disease; leaves open confirmation in prospective trials.
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.
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Bonino et al. (2019) conducted a review in Diabetic kidney disease. Antihypertensive treatment (RAAS inhibitors and BP control) was evaluated. Blood pressure reduction in diabetic kidney disease should be tailored to individual renal phenotypes to prevent paradoxical worsening of renal function at very low blood pressure levels.
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