Long-term antihypertensive treatment inhibiting progression of diabetic nephropathy

TLDR

All patients were of normal weight. The study aims to define the optimal antihypertensive treatment modality for early diabetic nephropathy in a large patient population. Six men aged 26–35 with insulin‑independent juvenile‑onset diabetes and proteinuria were treated for moderate hypertension and followed for 73 months to assess nephropathy progression. Antihypertensive therapy reduced systolic and diastolic blood pressure and slowed the decline in glomerular filtration rate from 1.23 to 0.49 ml/min per month (p = 0.042) while markedly decreasing albumin clearance from 107 % to 5 % (p = 0.0099), indicating a slowing of renal function decline in diabetic nephropathy.

Abstract

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.