Abstract

SAFE AND EFFECTIVE ANTI-HYPERTENSIVE DRUG THERAPY IN DIABETIC NEPHROPATHY- A META ANALYSIS

Dr. Keshav Kunwar*, Dr. Sina Zare, Dr. Miriam L. Hnamte and Bhubneswari Bhatt

Abstract

Diabetic nephropathy is a critical medical problem and the leading cause of end-stage renal disease. Some patients are characterized with albuminuria and renal failure where other patients are not as considering a long history of diabetes. Slowing progression of renal failure is an important factor to consider when selecting antihypertensive medications for patients with renal failure and proteinuria. Proteinuria is a sensitive and independent predictor for the progression of nephropathy and cardiovascular disease. Higher levels of proteinuria are associated with increased progression of renal and cardiovascular disease and that reductions in proteinuria are associated with a decrease in the rate of renal function deterioration and cardiovascular events Both the angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been shown to have these effects. However, the evidence for the renoprotective effects of calcium antagonists is more equivocal. Nondihydropyridine calcium antagonists (NDCAs) are superior to Nondihydropyridine calcium antagonists (DCAs) in reducing proteinuria. NDCAs, alone or in combination with an ACE inhibitor or an ARB, should be preferred over DCAs for treating hypertensive patients with proteinuric renal disease or renal insufficiency. Effective antihypertensive treatment postpones renal insufficiency in diabetic nephropathy. Both angiotensin converting enzyme (ACE) inhibitors and the nondihydropyridine calcium antagonists, (non-DHPCAs) reduce both arterial pressure and proteinuria in those with diabetic nephropathy significant reductions in proteinuria, findings not observed in the atenolol group. Spironolactone daily added to recommended antihypertensive treatment including ACE inhibitors and/or ARBs is well tolerated by reductions in blood pressure and albuminuria in type 2 diabetic patients with nephropathy.

Keywords: Diabetic nephropathy, Hypertension, albuminuria, End-stage renal disease.