Norgaard K
Steno Diabetes Center, Gentofte.
Dan Med Bull. 1996 Feb;43(1):21-38.
Hypertension is seen in approximately 85% of IDDM patients with diabetic nephropathy and blood pressure elevation is an early event in the development of this complication. In IDDM patients with clinical nephropathy, a positive correlation has been demonstrated between the blood pressure and the urinary albumin excretion and reduction of blood pressure reduces albuminuria as well as the rate of decline in glomerular filtration rate. Also extrarenal abnormalities such as retinopathy, cardiovascular diseases and signs of endothelial dysfunction, sometimes seen in non-diabetics with severe and/or prolonged hypertension, are frequently demonstrated in IDDM patients with clinical nephropathy. The aim of the present study was to provide circumstantial evidence for the thesis that hypertension in IDDM patients with nephropathy is secondary to the kidney involvement and not the cause of the kidney disease. Furthermore, by familial and physiological studies the review also aimed to contribute to the understanding of the pathogenesis of hypertension in patients with clinical nephropathy. Finally the question of optimal pharmacological antihypertensive treatment was discussed. It was demonstrated that in IDDM patients with elevated urinary albumin excretion above normal level the prevalence of hypertension is 60%, whereas in patients without signs of renal impairment hypertension is not more prevalent as in the age and sex-matched background population (about 4% in both groups). Based upon the observation, that some of these IDDM patients with hypertension but normal UAE were hypertensive for many years, we designated this group as IDDM patients with essential hypertension for further studies. In this group, we had the opportunity to study the association between blood pressure and the development of extrarenal complications in patients with IDDM. The group with essential hypertension and IDDM showed to have less retinopathy compared with diabetics with similar blood pressure but elevated UAE. In contrast to the hypertensive patients with nephropathy, a normal transcapillary escape rate of albumin and normal plasma levels of von Willebrand factor, of angiotensin-converting-enzyme and of inactive renin were demonstrated in the former group of patients. Thus, the extrarenal abnormalities found in IDDM patients with hypertension are more closely associated to the presence of albuminuria than to the elevation of blood pressure, indirectly supporting the hypothesis that hypertension per se is not the cause of these abnormalities in the IDDM patients with nephropathy. Furthermore, the present study does not disclose a genetic disposition to hypertension in IDDM patients with elevated UAE.
在患有糖尿病肾病的胰岛素依赖型糖尿病（IDDM）患者中，约85%可见高血压，且血压升高是该并发症发展过程中的早期事件。在患有临床肾病的IDDM患者中，已证实血压与尿白蛋白排泄之间存在正相关，血压降低可减少蛋白尿以及肾小球滤过率的下降速率。此外，肾外异常情况，如视网膜病变、心血管疾病和内皮功能障碍的体征，在患有严重和/或长期高血压的非糖尿病患者中有时可见，在患有临床肾病的IDDM患者中也经常出现。本研究的目的是为以下论点提供旁证：患有肾病的IDDM患者的高血压继发于肾脏受累，而非肾脏疾病的病因。此外，通过家族研究和生理学研究，该综述还旨在有助于理解临床肾病患者高血压的发病机制。最后讨论了最佳药物降压治疗的问题。结果表明，尿白蛋白排泄高于正常水平的IDDM患者中高血压患病率为60%，而无肾功能损害迹象的患者中高血压患病率并不高于年龄和性别匹配的背景人群（两组均约为4%）。基于一些患有高血压但尿白蛋白排泄正常的IDDM患者多年来一直高血压的观察结果，我们将该组指定为原发性高血压IDDM患者以进行进一步研究。在该组中，我们有机会研究IDDM患者血压与肾外并发症发生之间的关联。与血压相似但尿白蛋白排泄升高的糖尿病患者相比，原发性高血压IDDM组的视网膜病变较少。与患有肾病的高血压患者相反，前一组患者的白蛋白经毛细血管逸出率正常，血管性血友病因子、血管紧张素转换酶和无活性肾素的血浆水平正常。因此，患有高血压的IDDM患者中发现的肾外异常与蛋白尿的存在比与血压升高更密切相关，间接支持了以下假设：在患有肾病的IDDM患者中，高血压本身并非这些异常的病因。此外，本研究未揭示尿白蛋白排泄升高的IDDM患者存在高血压的遗传倾向。
