Effective antihypertensive strategies for high-risk patients with diabetic nephropathy

Peter Noel Van Buren, Beverley Adams-Huet, Robert Daniel Toto

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Aim: Clinical guidelines recommend blood pressure (BP) lowering and renin-angiotensin-aldosterone system inhibition to slow kidney disease progression in patients with diabetic nephropathy. This study's purpose was to determine whether an antihypertensive regimen including a maximally dosed angiotensin-converting enzyme inhibitor could safely achieve target BP in indigent, predominantly minority patients with this disease. Methods: We studied 81 hypertensive adults (52% Hispanic and 31% African American) with nephropathy attributed to type 1 or 2 diabetes during the run-in period of a randomized controlled trial. The subjects received lisinopril titrated to 80 mg daily and additional antihypertensives to target a systolic BP (SBP) lower than 130 mm Hg. Blood pressure and serum potassium level were measured weekly, and a 4-gram sodium diet was prescribed. The primary outcome variable was SBP change from screening to randomization. Success in achieving SBP goal, change in urine albumin-creatinine ratio, hyperkalemia (serum potassium ≥5.5 mmol/L) and hypotension (SBP < 100 mm Hg) were also analyzed. Results: The median SBP decreased from 144 to 133 mm Hg (median change,-9.6%.) Fifty-eight (71%) achieved goal SBP during run-in. The median UACR decreased from 206.8 to 112.7 mg/mmol (median change,-42.7%). The UACR reduction correlated with SBP reduction. Seventeen subjects experienced hyperkalemia responsive to dietary/medical management. Two subjects experienced hypotension responsive to medication adjustments. Conclusion: A regimen using a maximally dosed angiotensinconverting enzyme inhibitor is safe and effective for achieving BP goal in high-risk, predominantly minority patients with diabetic nephropathy. Implementing this regimen necessitates close monitoring of serum potassium level.

Original languageEnglish (US)
Pages (from-to)950-956
Number of pages7
JournalJournal of Investigative Medicine
Volume58
Issue number8
DOIs
StatePublished - Dec 2010

Fingerprint

Blood pressure
Diabetic Nephropathies
Antihypertensive Agents
Blood Pressure
Potassium
Hyperkalemia
Hypotension
Lisinopril
Serum
Angiotensins
Enzyme Inhibitors
Nutrition
Medical problems
Aldosterone
Angiotensin-Converting Enzyme Inhibitors
Renin
Kidney Diseases
Poverty
Renin-Angiotensin System
Random Allocation

Keywords

  • Albuminuria
  • Angiotensin-converting enzyme inhibitor
  • Diabetes
  • Hypertension
  • Nephropathy

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Effective antihypertensive strategies for high-risk patients with diabetic nephropathy. / Van Buren, Peter Noel; Adams-Huet, Beverley; Toto, Robert Daniel.

In: Journal of Investigative Medicine, Vol. 58, No. 8, 12.2010, p. 950-956.

Research output: Contribution to journalArticle

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abstract = "Aim: Clinical guidelines recommend blood pressure (BP) lowering and renin-angiotensin-aldosterone system inhibition to slow kidney disease progression in patients with diabetic nephropathy. This study's purpose was to determine whether an antihypertensive regimen including a maximally dosed angiotensin-converting enzyme inhibitor could safely achieve target BP in indigent, predominantly minority patients with this disease. Methods: We studied 81 hypertensive adults (52{\%} Hispanic and 31{\%} African American) with nephropathy attributed to type 1 or 2 diabetes during the run-in period of a randomized controlled trial. The subjects received lisinopril titrated to 80 mg daily and additional antihypertensives to target a systolic BP (SBP) lower than 130 mm Hg. Blood pressure and serum potassium level were measured weekly, and a 4-gram sodium diet was prescribed. The primary outcome variable was SBP change from screening to randomization. Success in achieving SBP goal, change in urine albumin-creatinine ratio, hyperkalemia (serum potassium ≥5.5 mmol/L) and hypotension (SBP < 100 mm Hg) were also analyzed. Results: The median SBP decreased from 144 to 133 mm Hg (median change,-9.6{\%}.) Fifty-eight (71{\%}) achieved goal SBP during run-in. The median UACR decreased from 206.8 to 112.7 mg/mmol (median change,-42.7{\%}). The UACR reduction correlated with SBP reduction. Seventeen subjects experienced hyperkalemia responsive to dietary/medical management. Two subjects experienced hypotension responsive to medication adjustments. Conclusion: A regimen using a maximally dosed angiotensinconverting enzyme inhibitor is safe and effective for achieving BP goal in high-risk, predominantly minority patients with diabetic nephropathy. Implementing this regimen necessitates close monitoring of serum potassium level.",
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