Parving H H
Hvidöre Hospital, Klampenborg, Denmark.
J Hypertens Suppl. 1990 Dec;8(7):S187-91.
The primary cause of arterial hypertension and of the increased morbidity and mortality in patients with insulin-dependent diabetes mellitus (IDDM) is diabetic nephropathy. About 35% of IDDM patients develop persistent albuminuria, an irreversible decline in the glomerular filtration rate and elevated blood pressure, which collectively contribute to the clinical syndrome of diabetic nephropathy. The excess mortality of IDDM patients with nephropathy is 80-100 times greater than that of an age- and sex-matched non-diabetic population. Diabetic nephropathy is the single most important cause of end-stage renal disease in the Western world, accounting for over a quarter of all such cases. Blood pressure elevation is a frequent finding, even in the early stages of diabetic nephropathy. Elevated blood pressure accelerates diabetic nephropathy, while an effective blood pressure reduction delays the progression of nephropathy and reduces albuminuria. A reduction in glomerular capillary hydraulic pressure may be the crucial factor. All previous reports dealing with the natural history of diabetic nephropathy have demonstrated a cumulative death rate of between 50% and 77% 10 years after the onset of nephropathy. Effective antihypertensive treatment has reduced this rate to 15-20%.
动脉高血压以及胰岛素依赖型糖尿病（IDDM）患者发病率和死亡率增加的主要原因是糖尿病肾病。约35%的IDDM患者会出现持续性蛋白尿、肾小球滤过率不可逆下降以及血压升高，这些共同构成了糖尿病肾病的临床综合征。患有肾病的IDDM患者的额外死亡率比年龄和性别匹配的非糖尿病人群高80至100倍。糖尿病肾病是西方世界终末期肾病的最重要单一病因，占所有此类病例的四分之一以上。血压升高是常见现象，即使在糖尿病肾病的早期阶段也是如此。血压升高会加速糖尿病肾病的发展，而有效的血压降低可延缓肾病进展并减少蛋白尿。肾小球毛细血管液压的降低可能是关键因素。此前所有关于糖尿病肾病自然病程的报告均表明，肾病发病10年后的累积死亡率在50%至77%之间。有效的抗高血压治疗已将这一比率降至15%至20%。
