Antihypertensive therapy and diabetic nephropathy

The combination of diabetes mellitus and arterial hypertension is very common. Arterial hypertension plays a key role in the development of diabetic nephropathy which is the main cause for end-stage renal failure in the western world. Early diagnosis by detection of microalbuminuria is necessary. Antihypertensive therapy should focus on a target blood pressure below 130/80 mmHg. Non-pharmacological therapy should include patient education on hypertension as well as dietary advice on salt restriction. Type 1 and 2 diabetics with nephropathy should start on ACE inhibitors or angiotensin receptor blockers and diuretics should be part of every therapy. In general, a combination therapy with several antihypertensive agents is often necessary. A more complete blockade of the renin-angiotensin-aldosterone system by combining ACE inhibitors, angiotensin receptor blockers and aldosterone antagonists can be recommended in certain cases and should be prescribed by clinicians who are very familiar with this therapy. Future therapeutic developments are currently undergoing clinical trials. © 2007 Springer-Verlag.