Arterial hypertension in patients with diabetic nephropathy

Abstract

Šećerna bolest najčešći je uzrok kroničnog bubrežnog zatajenja u svijetu. Dijabetička nefropatija je bolest koju karakteriziraju perzistentna proteinurija, pad glomerularne filtracije (GF), povišenje krvnog tlaka i progresija u završnoj fazi zatajenja bubrega. Hipertenzija je česta kod bolesnika s kroničnom bolesti bubrega (KBB) i šećerne bolesti. U ovoj populaciji hipertenzija povećava rizik za nastanak bolesti bubrega i napredovanja i kardiovaskularnog (KV) morbiditeta i mortaliteta. Dijabetička nefropatija (DN) je najčešći uzrok KBB u onih s dijabetesom. Mehanizam hipertenzije dijabetičke nefropatije je složen, nedovoljno razjašnjen, a uključuje višak zadržavanja natrija, simpatički živčani sustav (SNS) i aktivaciju renin-angiotenzin-aldosteron (RAAS) sistema, disfunkciju endotelnih stanica. Ti mehanizmi su odgovorni za nastanak i pogoršanje hipertenzije u ovoj populaciji i doprinijeli su povećanom riziku za nepovoljni KV ishod. Trenutno upravljanje hipertenzije kod dijabetičke nefropatije treba uključivati terapije koje blokiraju proizvodnju angiotenzina ili akciju i ciljeva liječenja krvnog tlaka s tim lijekova trebaju biti usmjereni na krvni tlak < 130/80 mmHg. Važno postizanje tog cilja će biti potrebno korištenje obje nefarmakološke intervencije u kombinaciji s više antihipertenzivnih lijekova. Nedavne studije istražuju korištenje kombiniranih terapija koje koriste više od jednog RAAS lijeka, te formalne preporuke čekaju svoje rezultate.Diabetes mellitus is the most common cause of chronic renal failure in the world. Diabetic nephropathy is a disease characterized by persistent proteinuria, decreased glomerular filtration rate (GF), blood pressure and progression to the final stage of kidney failure. Hypertension is common in patients with chronic kidney disease (CKD) and diabetes. In this population, hypertension increases the risk of kidney disease and progression of cardiovascular (CV) morbidity and mortality. Diabetic nephropathy (DN) is the most common cause of CKD in patients with diabetes. The mechanism of hypertension, diabetic nephropathy is complex and insufficiently understood, and includes the excess sodium retention, sympathetic nervous system (SNS) and the activation of Irene - angiotensin - aldosterone system (RAAS) system, dysfunction of the endothelium - muscle cells. These mechanisms are responsible for the development and aggravation of hypertension in this population and have contributed to the increased risk of adverse CV outcome. Current management of hypertension in diabetic nephropathy should include therapies that block the production or action of angiotensin and blood pressure treatment goals with these drugs should be focused on blood pressure < 130/80 mmHg. Important to the achievement of this goal will be necessary to use both non - pharmacological intervention in combination with more antihypertensive drugs. Recent studies investigating the use of combination therapy using more than one drug RAAS, and formal recommendations await their results