Role for beta-blockers in the management of diabetic kidney disease.

Diabetes is the number one cause of end-stage renal disease in the United States. Most patients with diabetic renal disease also have hypertension and additional cardiovascular (CV) risk factors. The leading cause of death among these patients is CV events. Treatment of hypertension in patients with diabetes is therefore of particular relevance. The goals of antihypertensive therapy are to lower blood pressure (BP), to slow the progression of kidney disease, and to reduce the risk of CV events. The recommended target BP in patients with chronic kidney disease, with or without diabetes, is <130/80 mm Hg. The majority of these patients will require more than one antihypertensive agent to control their BP; most will need more than two drugs. Data from numerous randomized clinical trials show that patients with diabetic kidney disease should receive an agent that blocks the renin-angiotensin system in combination with a diuretic, beta-blocker (betaB), or calcium channel blocker. Beta-blockers have an important dual role to play in the management of patients with diabetic kidney disease: to help achieve target BP, and to provide optimal cardioprotection in these patients who are at high risk for cardiac events.