Obesity Research and Management, University of Alberta, Royal Alexandra Hospital, Edmonton, AB, Canada.
Postgrad Med. 2011 May;123(3):109-21. doi: 10.3810/pgm.2011.05.2289.
Hypertension and diabetes are common risk factors for nephropathy as well as for neuropathy, retinopathy, cardiovascular disease, and cerebrovascular disease. Diabetic nephropathy occurs in 20% to 40% of patients with type 2 diabetes mellitus and is the single most important cause of end-stage renal disease (ESRD) worldwide, accounting for 40% to 45% of new cases in the United States. The incidence of ESRD is predicted to increase as the prevalence of type 2 diabetes mellitus and obesity continue to increase.
Clinical data from the recent classes of antihypertensive agents are reviewed in the context of hypertension reduction guidelines and prevention of diabetic nephropathy.
Numerous clinical trials have demonstrated that angiotensin receptor blockers (ARBs) are safe and effective antihypertensive treatments that slow the progression of renal disease in people with diabetes and/or hypertension, and macroalbuminuria.
The tolerable adverse event profile of ARBs and their renoprotective benefits beyond blood pressure reduction make ARBs a useful first-line treatment in people with, or at risk of developing, renal disease. As the incidence of obesity-related cardiovascular disease and renal risk factors continues to grow, future studies are required to directly assess the renoprotective effects of ARBs in overweight or obese patient subgroups. Because renin angiotensin system (RAS) inhibitors target the key mechanisms underlying these conditions, they may be particularly beneficial for the prevention of ESRD in the growing group of patients with obesity-related hypertension and the metabolic syndrome.
高血压和糖尿病是肾病以及神经病、视网膜病、心血管疾病和脑血管疾病的常见危险因素。2 型糖尿病患者中有 20%至 40%发生糖尿病肾病，是全世界终末期肾病（ESRD）的单一最重要原因，占美国新发病例的 40%至 45%。随着 2 型糖尿病和肥胖症的患病率继续增加，ESRD 的发病率预计将会增加。
根据高血压降低指南和预防糖尿病肾病，审查了最近几类抗高血压药物的临床数据。
大量临床试验表明，血管紧张素受体阻滞剂（ARBs）是安全有效的降压治疗药物，可减缓糖尿病和/或高血压以及大量白蛋白尿患者的肾脏疾病进展。
ARBs 的可耐受不良事件谱及其在降低血压以外的肾脏保护益处，使其成为有或有发生肾脏疾病风险的患者的有用一线治疗药物。随着肥胖相关心血管疾病和肾脏危险因素的发病率持续增长，需要进行未来的研究以直接评估 ARBs 在超重或肥胖患者亚组中的肾脏保护作用。由于肾素血管紧张素系统（RAS）抑制剂针对这些病症的关键机制，因此它们可能对预防肥胖相关高血压和代谢综合征患者中日益增多的 ESRD 特别有益。
