Aggressive multifactorial risk factor management, particularly with renin-angiotensin system inhibitors, is crucial for delaying the progression of diabetic nephropathy and reducing associated cardiovascular risk.
May support intensified multifactorial control in diabetic nephropathy; leaves open need for updated RCTs to guide targets.
Diabetic nephropathy is the leading cause of end stage renal disease worldwide and is associated with increased cardiovascular risk. The earliest clinical manifestation is of microalbuminuria. Tight blood glucose and blood pressure control reduce the risk of microalbuminuria. Once microalbuminuria is present, the rate of progression to end stage renal disease and of cardiovascular disease can be delayed by aggressive management of blood pressure, glucose, and lipids. Inhibition of the renin-angiotensin system is important to reduce intraglomerular pressure but other classes of antihypertensive agent may also be needed to gain adequate control of systemic blood pressure. Such measures can at least half the rate of progression of nephropathy and cardiovascular disease.
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Sally M. Marshall (2004) studied this question.
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