Hypertension and nephropathy.

Nearly 90% of patients with hypertension and diabetes mellitus do not reach the recommended systolic blood pressure goal of <130 mm Hg. Consequently, the risk of cardiovascular and renal complications remains significant in this patient population. Study results suggest that initiating therapy with inhibitors of the renin-angiotensin system and adding diuretics may be useful in reducing arterial pressure to levels <130 mm Hg and may attenuate the progression of nephropathy. Recently, numerous studies have also found that the thiazolidinediones (TZDs) may improve insulin resistance and exert beneficial vascular effects in patients with type 2 diabetes. The TZDs have a range of vascular benefits, including mediating vasorelaxation, inhibiting angiogenesis, and improving inflammation. These findings have been associated with reduction in blood pressure and prevention of microalbuminuria. In patients with type 2 diabetes, early use of TZDs may be beneficial in both achieving glucose control and reducing the development or worsening of microalbuminuria or hypertension.