SAFE AND EFFECTIVE ANTI-HYPERTENSIVE DRUG THERAPY IN DIABETIC NEPHROPATHY- A META ANALYSIS
Dr. Keshav Kunwar*, Dr. Sina Zare, Dr. Miriam L. Hnamte and Bhubneswari Bhatt
ABSTRACT
Diabetic nephropathy is a critical medical problem and the leading
cause of end-stage renal disease. Some patients are characterized with
albuminuria and renal failure where other patients are not as
considering a long history of diabetes. Slowing progression of renal
failure is an important factor to consider when selecting
antihypertensive medications for patients with renal failure and
proteinuria. Proteinuria is a sensitive and independent predictor for the
progression of nephropathy and cardiovascular disease. Higher levels
of proteinuria are associated with increased progression of renal and
cardiovascular disease and that reductions in proteinuria are associated
with a decrease in the rate of renal function deterioration and
cardiovascular events Both the angiotensin converting enzyme (ACE) inhibitors and
angiotensin receptor blockers (ARBs) have been shown to have these effects. However, the
evidence for the renoprotective effects of calcium antagonists is more equivocal.
Nondihydropyridine calcium antagonists (NDCAs) are superior to Nondihydropyridine
calcium antagonists (DCAs) in reducing proteinuria. NDCAs, alone or in combination with
an ACE inhibitor or an ARB, should be preferred over DCAs for treating hypertensive
patients with proteinuric renal disease or renal insufficiency. Effective antihypertensive
treatment postpones renal insufficiency in diabetic nephropathy. Both angiotensin converting
enzyme (ACE) inhibitors and the nondihydropyridine calcium antagonists, (non-DHPCAs)
reduce both arterial pressure and proteinuria in those with diabetic nephropathy significant
reductions in proteinuria, findings not observed in the atenolol group. Spironolactone daily
added to recommended antihypertensive treatment including ACE inhibitors and/or ARBs is well tolerated by reductions in blood pressure and albuminuria in type 2 diabetic patients with
nephropathy.
Keywords: Diabetic nephropathy, Hypertension, albuminuria, End-stage renal disease.
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