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Antihypertensive Treatment in Diabetic Kidney Disease: The Need for a Patient-Centered Approach

1
Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, Viale Benedetto XV 6, 16132 Genoa, Italy
2
IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, 71013 San Giovanni Rotondo (FG), Italy
3
Department of Clinical and Experimental Medicine, University of Messina, Piazza Pugliatti 1, 98122 Messina, Italy
*
Author to whom correspondence should be addressed.
Medicina 2019, 55(7), 382; https://doi.org/10.3390/medicina55070382
Received: 4 June 2019 / Revised: 2 July 2019 / Accepted: 12 July 2019 / Published: 16 July 2019
(This article belongs to the Special Issue Carbohydrate and Insulin Metabolism in Chronic Kidney Disease)
Diabetic kidney disease affects up to forty percent of patients with diabetes during their lifespan. Prevention and treatment of diabetic kidney disease is currently based on optimal glucose and blood pressure control. Renin–angiotensin aldosterone inhibitors are considered the mainstay treatment for hypertension in diabetic patients, especially in the presence of albuminuria. Whether strict blood pressure reduction entails a favorable renal outcome also in non-albuminuric patients is at present unclear. Results of several clinical trials suggest that an overly aggressive blood pressure reduction, especially in the context of profound pharmacologic inhibition of the renin–angiotensin–aldosterone system may result in a paradoxical worsening of renal function. On the basis of this evidence, it is proposed that blood pressure reduction should be tailored in each individual patient according to renal phenotype. View Full-Text
Keywords: diabetes; blood pressure target; RAAS inhibitors; SGLT-2 inhibitors; renal outcome; cardiovascular outcome diabetes; blood pressure target; RAAS inhibitors; SGLT-2 inhibitors; renal outcome; cardiovascular outcome
MDPI and ACS Style

Bonino, B.; Leoncini, G.; De Cosmo, S.; Greco, E.; Russo, G.T.; Giandalia, A.; Viazzi, F.; Pontremoli, R. Antihypertensive Treatment in Diabetic Kidney Disease: The Need for a Patient-Centered Approach. Medicina 2019, 55, 382.

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