Blood pressure level the main haemodynamic basis

A rise in blood pressure is usually seen in parallel with microalbuminuria, at least in type 1 diabetes [77-82]. However, there is clearly an overlap in blood pressure between normo-, micro- and macroalbuminuria even after careful matching for age, sex and duration of diabetes [65].

In type 2 diabetes, blood pressure is usually increased with microalbuminuria, but again there is a huge overlap, and many patients with type 2 diabetes have elevated blood pressure even with normoalbuminuria and at the clinical diagnosis of diabetes [83]. This may be related to the metabolic syndrome or to simple obesity.

Ambulatory 24-hour blood pressure recordings give precise and detailed information [77], and it appears that blood pressure is increased in patients with renal complications. In follow up studies, there is an increase in blood pressure by about 3-4 mmHg per year in patients with microalbuminuria as compared with normoalbuminuric patients where the increase in blood pressure is usually 1 mmHg per year. In overt nephropathy, the increase is around 5-6 mmHg per year [1].

The best evidence for the importance of the need to control blood pressure stems from clinical trials. Several clinical trials in type 1 diabetes have shown that effective treatment of elevated blood pressure is important in slowing down progression. Even the treatment of blood pressure within the normal range appears to be beneficial, especially when using ACE inhibitors in microalbuminuric patients [58, 83-89].

To conclude, there is no clear-cut correlation between blood pressure level and development of renal disease; rather, the two abnormalities are characterized by a considerable overlap. However, a low blood pressure level is usually associated with a good prognosis. Careful monitoring of blood pressure is obviously of paramount importance in the management of diabetic patients.

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