Commentary: Should BP targets be lower in diabetic patients with microalbuminuria or nephropathy?

Abstract

The authors in the preceding paper have answered a number of specific questions regarding the management of diabetic renal disease. Using a systematic review, they have concluded that although urinary albumin excretion decreases in patients randomised to lower blood pressure (BP) levels within the normotensive range (< 140/90 mmHg), no trials to-date have demonstrated a beneficial effect on glomerular filtration rate (GFR). Thus, the authors state that the available literature does not provide dat S a to support the assertion that BP-lowering within the normotensive range reduces the risk of renal replacement therapy. However, these findings require interpretation before they can influence clinical practice. The benefits of BP-lowering extend far beyond the glomerulus — a fact of crucial importance in terms of the macrovasculopathy so frequently seen inpatients with diabetic renal disease. Moreover, achieving BP levels within the normotensive range in these patients is in itself a success. The analysis provided by Kaiser et al. does suggest that, rather than lowering BP within the normotensive range, other therapeutic avenues may be more fruitfully explored to maximise health gain in this high-risk cohort.