Management of hypertension and renin-angiotensin-aldosterone system blockade in adults with diabetic kidney disease: Association of British Clinical Diabetologists and the Renal Association UK guideline update 2021

被引：53

作者：

Banerjee, D. ^{[1
]}

Winocour, P. ^{[2
]}

Chowdhury, T. A. ^{[3
]}

De, P. ^{[4
]}

Wahba, M. ^{[5
]}

Montero, R. ^{[6
]}

Fogarty, D. ^{[7
]}

Frankel, A. H. ^{[8
]}

Karalliedde, J. ^{[9
]}

Mark, P. B. ^{[10
]}

Patel, D. C. ^{[11
]}

Pokrajac, A. ^{[12
]}

Sharif, A. ^{[13
]}

Zac-Varghese, S. ^{[2
]}

Bain, S. ^{[14
]}

Dasgupta, I ^{[13
]}

机构：

[1] St Georges Hosp NHS Fdn Trust, London, England

[2] East & North Herts NHS Trust, ENHIDE, Stevenage, Herts, England

[3] Royal London Hosp, London, England

[4] City Hosp, Birmingham, W Midlands, England

[5] St Helier Hosp, Carshalton, Surrey, England

[6] Kings Coll London, London, England

[7] Belfast Hlth & Social Care Trust, Belfast, Antrim, North Ireland

[8] Imperial Coll Healthcare NHS Trust, London, England

[9] Guys & St Thomas Hosp London, London, England

[10] Univ Glasgow, Glasgow, Lanark, Scotland

[11] Royal Free London NHS Fdn Trust, London, England

[12] West Hertfordshire Hosp, London, England

[13] Univ Hosp Birmingham NHS Fdn Trust, Birmingham, W Midlands, England

[14] Swansea Univ, Swansea, W Glam, Wales

来源：

BMC NEPHROLOGY | 2022年 / 23卷 / 01期

关键词：

Diabetes; Hypertension; Chronic kidney disease; dialysis; ACE inhibitors; Angiotensin receptor blockers; BLOOD-PRESSURE CONTROL; CONVERTING-ENZYME-INHIBITORS; RANDOMIZED CONTROLLED-TRIAL; LEFT-VENTRICULAR HYPERTROPHY; CARDIOVASCULAR RISK-FACTORS; URINARY ALBUMIN EXCRETION; ALL-CAUSE MORTALITY; CALCIUM-CHANNEL BLOCKERS; PLACEBO-CONTROLLED TRIAL; II RECEPTOR BLOCKADE;

D O I：

10.1186/s12882-021-02587-5

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

People with type 1 and type 2 diabetes are at risk of developing progressive chronic kidney disease (CKD) and end-stage kidney failure. Hypertension is a major, reversible risk factor in people with diabetes for development of albuminuria, impaired kidney function, end-stage kidney disease and cardiovascular disease. Blood pressure control has been shown to be beneficial in people with diabetes in slowing progression of kidney disease and reducing cardiovascular events. However, randomised controlled trial evidence differs in type 1 and type 2 diabetes and different stages of CKD in terms of target blood pressure. Activation of the renin-angiotensin-aldosterone system (RAAS) is an important mechanism for the development and progression of CKD and cardiovascular disease. Randomised trials demonstrate that RAAS blockade is effective in preventing/ slowing progression of CKD and reducing cardiovascular events in people with type 1 and type 2 diabetes, albeit differently according to the stage of CKD. Emerging therapy with sodium glucose cotransporter-2 (SGLT-2) inhibitors, non-steroidal selective mineralocorticoid antagonists and endothelin-A receptor antagonists have been shown in randomised trials to lower blood pressure and further reduce the risk of progression of CKD and cardiovascular disease in people with type 2 diabetes. This guideline reviews the current evidence and makes recommendations about blood pressure control and the use of RAAS-blocking agents in different stages of CKD in people with both type 1 and type 2 diabetes.

引用

页数：31

共 298 条

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