According to the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, high blood pressure for adults is defined as:
140 mm Hg or greater systolic pressure
90 mm Hg or greater diastolic pressure
In an update of NHLBI guidelines for hypertension in 2003, a new blood pressure category was added called prehypertension:
120 mm Hg – 139 mm Hg systolic pressure
80 mm Hg – 89 mm Hg diastolic pressure
The new NHLBI guidelines now define normal blood pressure as follows:
Less than 120 mm Hg systolic pressure
Less than 80 mm Hg diastolic pressure
Nephropathy is the deterioration of the kidneys. The final stage of nephropathy is called kidney failure, end-stage renal disease, or ESRD.
According to the CDC, diabetes is the most common cause of ESRD, accounting for about 44 percent of all new cases of kidney failure in 2008. In 2011, about 25.8 million people in the U.S. have diabetes, and more than 202,290 people with ESRD due to diabetes were either on chronic renal dialysis or had a kidney transplant. Both type 1 and type 2 diabetes can lead to diabetic nephropathy, although type 1 is more likely to lead to ESRD.
There are five stages of diabetic nephropathy, or deterioration of the kidneys. The fifth stage is ESRD. Progress from one stage to the next can take many years, with 23 years being the average length of time to reach stage five.
Hypertension, or high blood pressure, is a complication of diabetes that is believed to contribute most directly to diabetic nephropathy. Hypertension is believed to be both a cause of diabetic nephropathy, as well as a result of the damage that is created by the disease. As kidney disease progresses, physical changes in the kidneys often lead to increased blood pressure.
Uncontrolled hypertension can make the progress toward stage five diabetic nephropathy occur more rapidly.
The onset and progression of diabetic nephropathy can be slowed by intensive management of diabetes and its symptoms, including taking medications to lower blood pressure.
Specific treatment for diabetic nephropathy will be determined by your doctor based on:
Treatment may include any, or a combination of, the following:
Treatment for ESRD often initially includes dialysis to cleanse the blood, and, eventually, kidney transplantation may also be a consideration.
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