BENEFITS OF LONG-TERM ANTIHYPERTENSIVE TREATMENT ON PROGNOSIS IN DIABETIC NEPHROPATHY

We assessed the prognosis of diabetic nephropathy during long-term ant ihypertensive treatment as compared to the prognosis during the natura l history of this complication in a prospective study of all IDDM pati ents (N = 45) aged under 50 with onset of diabetes before the age of 3 1 who developed diabetic nephropathy between 1974 and 1978 at Steno Di abetes Center, and were followed until death or for at least 16 years [median 16 (4 to 21) years]. Antihypertensive treatment was started 3 (0 to 13) years after onset of diabetic nephropathy. Mean arterial blo od pressure at start of antihypertensive treatment was 148/96 (SD 12/1 0) mm Hg and 143/86 (16/6) mm Hg during the whole interval of antihype rtensive treatment (P < 0.01). The cumulative death rate was 45% (95% C.I. 38 to 52) 16 years after onset of diabetic nephropathy, in contra st to previous reports 88% and 94% 12 and 16 years after onset of diab etic nephropathy, respectively. The median survival time in our study exceeded 16 years as compared to five and seven years in untreated pat ients in the past. Uremia was the main cause of death (12 patients; 55 %). In 1994 serum creatinine was 116 (74 to 311) mu mol/liter in the 2 3 surviving patients. The preservation of kidney function and the prog nosis of diabetic nephropathy has improved during the past two decades mainly because of effective antihypertensive treatment.