A N Isaacs1,2, A Vincent1,3. 1. Purdue University College of Pharmacy, Department of Pharmacy Practice, West Lafayette, IN, USA. 2. Eskenazi Health, Department of Pharmacy Services, Indianapolis, IN, USA. 3. Indiana University Health, Methodist Hospital, Department of Pharmacy, Indianapolis, IN, USA.
Abstract
WHAT IS KNOWN AND OBJECTIVE: Although antihypertensive recommendations exist for diabetic nephropathy, there is less guidance for diabetics with normoalbuminuria. Therefore, this review evaluates antihypertensives in preventing nephropathy in diabetic hypertensive patients. COMMENT: A literature search was performed using PubMed and Medline for primary literature from 1978 through August 2015. Search terms included diabetes mellitus, normoalbuminuria, hypertension, ACE inhibitor, ARB and calcium channel blocker. There was no literature evaluating antihypertensive therapies in preventing nephropathy in type 1 hypertensive diabetics. However, in patients with type 2 diabetes and hypertension, multiple studies demonstrate the benefit of an ACEI or ARB in preventing or delaying the onset of nephropathy, while no study demonstrated the benefit of a CCB over an ACEI or ARB. WHAT IS NEW AND CONCLUSION: Due to the lack of literature, hypertension management in type 1 diabetics with normoalbuminuria should be guided by the treatment of comorbidities. To prevent diabetic nephropathy, an ACEI or ARB should be first-line monotherapy over a CCB for the management of hypertension in patients with type 2 diabetes mellitus, hypertension and normoalbuminuria.
WHAT IS KNOWN AND OBJECTIVE: Although antihypertensive recommendations exist for diabetic nephropathy, there is less guidance for diabetics with normoalbuminuria. Therefore, this review evaluates antihypertensives in preventing nephropathy in diabetic hypertensivepatients. COMMENT: A literature search was performed using PubMed and Medline for primary literature from 1978 through August 2015. Search terms included diabetes mellitus, normoalbuminuria, hypertension, ACE inhibitor, ARB and calcium channel blocker. There was no literature evaluating antihypertensive therapies in preventing nephropathy in type 1 hypertensive diabetics. However, in patients with type 2 diabetes and hypertension, multiple studies demonstrate the benefit of an ACEI or ARB in preventing or delaying the onset of nephropathy, while no study demonstrated the benefit of a CCB over an ACEI or ARB. WHAT IS NEW AND CONCLUSION: Due to the lack of literature, hypertension management in type 1 diabetics with normoalbuminuria should be guided by the treatment of comorbidities. To prevent diabetic nephropathy, an ACEI or ARB should be first-line monotherapy over a CCB for the management of hypertension in patients with type 2 diabetes mellitus, hypertension and normoalbuminuria.
Authors: Mayara Karla Dos Santos Nunes; Alexandre Sérgio Silva; Isabella Wanderley de Queiroga Evangelista; João Modesto Filho; Cecília Neta Alves Pegado Gomes; Rayner Anderson Ferreira do Nascimento; Rafaella Cristhine Pordeus Luna; Maria José de Carvalho Costa; Naila Francis Paulo de Oliveira; Darlene Camati Persuhn Journal: Diabetol Metab Syndr Date: 2017-10-18 Impact factor: 3.320