The renal involvement in hypertension and type 2 diabetes mellitus: how to identify and to prevent? A vision of the cardiologist

Abstract

Revista HUPE, Rio de Janeiro, 2013;12(Supl 1):44-52

doi:10.12957/rhupe.2013.7082

Hypertension and type 2 diabetes are cardiovascular risk factors that frequently coexist. These clinical conditions have great epidemiologic impact, high-cost medical-social and economic. Very often these two conditions occur with some degree of renal injury and is the leading cause of nephropathy terminal. For all this the control of blood pressure, blood glucose and serum lipids are essential to prevent or at least delay the development of diabetic nephropathy. The benefit of more intensive glucose control in preventing diabetic nephropathy and macrovascular and microvascular complications is not fully established. Similarly, evidences from literature have demonstrated the benefit of reducing BP values for 130-135/80 mmHg in diabetics. However, larger decreases in BP have limited evidence. The treatment of hypertension and DM should involve lifestyle changes and drug therapy concomitantly. All classes of antihypertensive drugs are able to reduce the PA and therefore contribute to the prevention of diabetic nephropathy, however, highlight the benefits of blockers of the renin angiotensin aldosterone system. The choice of hypoglycemic scheme will be based on the values of fasting glucose, postprandial and HbA1c, weight and age of the patient, the presence of associated complications and the interaction with other drugs. The authors discuss in this article the goals of treatment for BP and blood glucose, the outlines of drug and non-drug treatment of hypertension and DM, as well as key strategies for renal protection, in view of the cardiologist.

Keywords: Hypertension; Diabetes mellitus; Diabetic nephropathies.