Preserving renal function in adults with hypertension and diabetes: A consensus approach

Over 11 million Americans have both diabetes and hypertension-comorbid dise ases that strongly predispose people to both renal as well as cardiovascula r (CV) injury. Hypertension substantially contributes to CV morbidity and m ortality in people with diabetes. Diabetes is the most common cause of end- stage renal disease in the United States. Furthermore, hypertension and dia betes are particularly prevalent in certain populations, such as African-Am ericans and Native Americans. Since the 1994 Working Group Report on Hypert ension and Diabetes, a large body of clinical trial data has affirmed the o riginal blood pressure goal of less than 130/85 mmHg recommended to preserv e renal function and reduce CV events in people with hypertension and diabe tes. Data that are more recent have emerged, however, to support an even lo wer diastolic blood pressure goal, ie, 80 mmHg, in order to optimally prese rve renal function and reduce CV events in people with diabetic nephropathy . A review of clinical trials indicates that more than 65% of people with d iabetes and hypertension will require two or more different antihypertensiv e medications to achieve the new suggested target blood pressure of 130/80 mmHg. The purpose of this report is to update the previous recommendations with a focus on level of blood pressure control, proteinuria reduction, and therapeutic approaches to achieve these goals. We provide an evidence-base d approach, integrating data from the major clinical trials that were desig ned as randomized prospective, long-term studies that had as a primary endp oint either progression of diabetic nephropathy or reduction in CV events. This report also addresses socioeconomic and cultural barriers that hinder achievement of blood pressure goals. Lastly, the report discusses approache s to resolve cultural barriers, both physician- and patient-derived, that i nterfere with achievement of lower blood pressure goals. (C) 2000 by the Na tional Kidney Foundation, Inc.