Antihypertensive therapy in diabetes.

Approximately one third of patients with IDDM develop end-stage renal disease. About the same percentage, though not of certainty the same patients, have elevated GFRs and plasma flow rates early in their disease and probably have elevated capillary pressure. Arterial hypertension in the setting of this pattern of renal vasodilation may be particularly predisposing to glomerular injury. Treatment of established diabetic nephropathy with good antihypertensive control can dramatically reduce the rate of progression of the disease. However, blood pressure control should be targeted to near normal ranges, that is, mean arterial pressures less than 100 mmHg and preferably lower. Some agents may be particularly beneficial in slowing the progression of the disease, but even standard agents have very important effects.