www.diabeticretinopathy.org.uk

General

Blood pressure and diabetes..organising safe care

David Kinshuck

 

What effect does blood pressure control have on renal function in practice?

This graph is taken from an audit of the diabetes renal service at Heart of England NHS FT carried out by Dr Hugh Rayner (hugh.rayner@ heartofengland.nhs.uk). Patients were reviewed if their GFR dropped below 50ml/min/1.73m2 (age <65 years) or 40 (all patients). With the extra attention from the renal clinic physicians lowering the blood pressure, the drop in GFR was halted or slowed down significantly.

blood pressure control iprevents progrssion of renal disease in diabetes

Of course some people did progress to renal failure, but the rate of deterioration was greatly slowed.

The renal clinic physicians concentrated on blood pressure, lowering it as much as possible. This was achieved using steps such as those described on this page.

Good control of blood pressure is important. But in patients who have only just become diabetic, particularly type 1 patients, if the blood pressure is normal, treament is not needed. Control of blood pressure is very helpful reducing retinopathy etc when the retinopathy has actually developed. It is the HbA1c that is important at the onset. Diabetic nephropathy can be reversed if the HbA1c and blood pressure are extremely well controlled.

 

Screening all biochemistry results.

A register was kept of diabetic patients who had attended a hospital clinic. Their blood results were sent to a database and those with a GFR dropping below 50 (aged <65 years) or 40 (all patients) were identified by a computer enquiry each week.

 

The treatment: patient ownership

First, the cause of the kidney disease was identified, and non-diabetic causes were treated. Most were diabetes related and the renal physician targeted blood pressure. In the meantime the patient's diabetic physician was notified so he could control the diabetes as well as possible.

Concerning blood pressure, the drugs used were similar to those described (link given).

Renal failure

Stroke

See. The irsk of recurrent stroke risks are related to systolic blood pressure SBP:

New Drugs

Endothelin receptor antagonist bosentan improves peripheral endothelial function 2012

 

Renal Denervation

see