Diabetes mellitus - Application of an antihypertensive therapy

Treating hypertension and microalbuminuria is one of the most important tasks next to blood glucose control in the treatment of adolescents with diabetes mellitus type 1. Normoglycemia as well as normotensive blood pressure values are able to prevent cardiac, vascular and renal complications of diabetes. The prevalence of arterial hypertension in patients with diabetes is considerably higher compared to the general population. The development of diabetic nephropathy is strongly associated with arterial hypertension. Diabetic nephropathy can be regarded either as cause or result of hypertension. Microalbuminuria, which can be observed already in childhood and adolescence, is the earliest indicator of progressive renal destruction. One of the most serious complications of juvenile diabetes still is terminal renal failure. Recent studies demonstrate that familial and genetic factors play an important role in the pathogenesis of diabetic nephropathy. Early identification of patients at risk is warranted. Regular measurement of arterial blood pressure and routine urine analysis for albuminuria is a prerequisite of the care of children and adolescents with diabetes. Early intervention, especially treatment with ACE inhibitors will improve the prognosis for diabetic nephropathy in adolescents with elevated blood pressure and/or microalbuminuria.