ACE-I and ARB and Blood Pressure Lowering, Including Effect on Renal Disease. Treatment of Advanced Diabetic Renal Disease

摘要: Hypertension is the main risk factor for renal as well atherosclerotic disease in diabetes, and quest strict blood pressure (BP) control has continuously evolved over last three decades. It was first described 30 years ago that decline glomerular filtration rate (GFR) correlated with systemic BP patients overt diabetic nephropathy [1]. This contrast to prevailing concept a certain level of elevation essential preservation organ perfusion general [2]. In subsequent years, however, data numerous studies have confirmed major determinant progression toward end-stage failure [3–7]. early observation [1] formed part basis antihypertensive treatment nephropathy, one most clinically significant interventions modern diabetology, documented preserve GFR [8–11] reduce mortality [12–15]. this chapter, we will focus on clinical aspects intervention renin–angiotensin system (RAS). Treatment angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB), relation other regimes (the BP-independent renoprotection), whether ACE-I ARB, should be first-line therapy combination ARB (dual blockade).