The effect of blood glucose and blood pressure control on the progression of diabetic nephropathy

Although diabetic nephropathy is a slowly progressing, well studied disease , it is the most common cause of end stage renal disease in industrialized countries. Recently the first randomized controlled long term trials about microvascular complications in patients with type 2 diabetes have been publ ished. Only seven years ago the first hallmark papers about metabolic contr ol and ACE inhibition emerged. This review highlights the current status of prevention and therapy of diabetic nephropathy by metabolic and blood pres sure control in type 1 and type 2 diabetic patients, depending on their sta ge of nephropathy (normo-, micro-, or macroalbuminuria). In patients with t ype 1 diabetes and normo- or microalbuminuria, strict metabolic control has been shown to slow the progression of nephropathy. In macroalbuminuric pat ients an aggressive antihypertensive treatment, preferably with an ACE inhi bitor, is more important than the metabolic control. ACE inhibitor therapy has also been proven beneficial in microalbuminuric patients, but not yet i n normotensive, non-albuminuric type 1 patients. Because of the high preval ence of hypertension in patients with type 2 diabetes, a strict antihyperte nsive treatment is more important than metabolic control for the prevention of progression of microvascular disease. Since most patients need a combin ation of antihypertensive medications a recommendation for a single substan ce class can not be given.