St George's Hospitals NHS Foundation Trust, London, UK.
ENHIDE, East and North Herts NHS Trust, Stevenage, UK.
BMC Nephrol. 2022 Jan 3;23(1):9. doi: 10.1186/s12882-021-02587-5.
People with type 1 and type 2 diabetes are at risk of developing progressive chronic kidney disease (CKD) and end-stage kidney failure. Hypertension is a major, reversible risk factor in people with diabetes for development of albuminuria, impaired kidney function, end-stage kidney disease and cardiovascular disease. Blood pressure control has been shown to be beneficial in people with diabetes in slowing progression of kidney disease and reducing cardiovascular events. However, randomised controlled trial evidence differs in type 1 and type 2 diabetes and different stages of CKD in terms of target blood pressure. Activation of the renin-angiotensin-aldosterone system (RAAS) is an important mechanism for the development and progression of CKD and cardiovascular disease. Randomised trials demonstrate that RAAS blockade is effective in preventing/ slowing progression of CKD and reducing cardiovascular events in people with type 1 and type 2 diabetes, albeit differently according to the stage of CKD. Emerging therapy with sodium glucose cotransporter-2 (SGLT-2) inhibitors, non-steroidal selective mineralocorticoid antagonists and endothelin-A receptor antagonists have been shown in randomised trials to lower blood pressure and further reduce the risk of progression of CKD and cardiovascular disease in people with type 2 diabetes. This guideline reviews the current evidence and makes recommendations about blood pressure control and the use of RAAS-blocking agents in different stages of CKD in people with both type 1 and type 2 diabetes.
1 型和 2 型糖尿病患者存在发生进行性慢性肾脏病(CKD)和终末期肾衰竭的风险。高血压是糖尿病患者发生白蛋白尿、肾功能受损、终末期肾病和心血管疾病的一个主要的、可逆转的危险因素。血压控制已被证明对减缓肾脏疾病进展和减少心血管事件有益。然而,随机对照试验证据在 1 型和 2 型糖尿病以及 CKD 的不同阶段在目标血压方面存在差异。肾素-血管紧张素-醛固酮系统(RAAS)的激活是 CKD 和心血管疾病发展和进展的重要机制。随机试验表明,RAAS 阻断在预防/减缓 1 型和 2 型糖尿病患者的 CKD 进展和减少心血管事件方面是有效的,尽管根据 CKD 阶段的不同而有所不同。钠-葡萄糖共转运蛋白-2(SGLT-2)抑制剂、非甾体选择性盐皮质激素拮抗剂和内皮素-A 受体拮抗剂等新兴疗法已在随机试验中证明可降低血压,并进一步降低 2 型糖尿病患者 CKD 和心血管疾病进展的风险。本指南回顾了当前的证据,并就 1 型和 2 型糖尿病患者在 CKD 不同阶段的血压控制和使用 RAAS 阻断剂提出了建议。
Adv Chronic Kidney Dis. 2014-5
Nat Rev Nephrol. 2010-5-4
G Ital Nefrol. 2007
Curr Med Res Opin. 2008-5
BMC Nephrol. 2025-2-8
Naunyn Schmiedebergs Arch Pharmacol. 2025-5