Hypertension has been recognized as an early and constant feature of diabet
ic nephropathy. but recent studies also suggest that a genetic predispositi
on to hypertension is an important risk factor for diabetic nephropathy. An
tihypertensive treatment attenuates progression in diabetic nephropathy, bu
t there is increasing evidence that very early treatment and very low targe
t blood pressures should be implemented. There is also evidence for local a
ctivation of the renin system in the kidney as a result of hyperglycaemia.
Apart from blood pressure. proteinuria should be monitored and dosing of AC
E inhibitors should be guided. also by reduction of protein excretion.