Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, Viale Benedetto XV 6, 16132 Genoa, Italy.
IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, 71013 San Giovanni Rotondo (FG), Italy.
Medicina (Kaunas). 2019 Jul 16;55(7):382. doi: 10.3390/medicina55070382.
Diabetic kidney disease affects up to forty percent of patients with diabetes during their lifespan. Prevention and treatment of diabetic kidney disease is currently based on optimal glucose and blood pressure control. Renin-angiotensin aldosterone inhibitors are considered the mainstay treatment for hypertension in diabetic patients, especially in the presence of albuminuria. Whether strict blood pressure reduction entails a favorable renal outcome also in non-albuminuric patients is at present unclear. Results of several clinical trials suggest that an overly aggressive blood pressure reduction, especially in the context of profound pharmacologic inhibition of the renin-angiotensin-aldosterone system may result in a paradoxical worsening of renal function. On the basis of this evidence, it is proposed that blood pressure reduction should be tailored in each individual patient according to renal phenotype.
糖尿病肾病影响多达百分之四十的糖尿病患者在他们的一生中。糖尿病肾病的预防和治疗目前基于最佳的血糖和血压控制。肾素-血管紧张素-醛固酮抑制剂被认为是糖尿病患者高血压的主要治疗方法，特别是在白蛋白尿的情况下。在非白蛋白尿患者中，严格降压是否也能带来有利的肾脏结局目前尚不清楚。几项临床试验的结果表明，过于积极的降压治疗，特别是在肾素-血管紧张素-醛固酮系统的深度药物抑制的情况下，可能导致肾功能的反常恶化。基于这一证据，有人提出，应根据肾脏表型对每个患者的血压降低进行个体化调整。
