hypertension (in Type I diabetics with nephropathy)
Last reviewed 01/2018
- hypertension in type I diabetics is often an indication of diabetic nephropathy
- in type I diabetics blood pressure reduction and ACE inhibitors slow the rate of decline of renal function in overt diabetic nephropathy; also they delay the progression from microalbuminuric phase to overt nephropathy
- ACE inhibition should be titrated to the maximum dose tolerated and recommended
- the target blood pressure is described in the menu item
- combination therapy is invariably required to achieve blood pressure targets
- even in the presence of a normal blood pressure Type I diabetics with persistent microalbuminuria or proteinuria may also benefit from ACE-inhibition titrated to the recommended maximum dose
- in the presence of frank proteinuria, in addition to BP control with ACE
inhibitors; some suggest protein intake should be reduced to <0.6 g/kg
body weight/day
- measures should also be taken to alter other risk factors such as smoking, obesity and dyslipidaemia