Recent trends in hypertension and diabetes therapy

Abstract

Hypertension and diabetes often appear together and increase cardiovascular mortality. Both diseases do frequently occur in patients with a severe course of COVID-19 (coronavirus disease 2019). Data in the literature are contradictory. A surrogate effect seems to be likely since older patients do often present a severe course due to their pre-existing pathologic conditions. Renin–angiotensin–aldosterone system (RAAS) inhibitors do not increase the probability of a positive test for SARS-CoV‑2 (severe acute respiratory syndrome coronavirus 2). They have no impact on the severity or mortality and must not be discontinued. Renal denervation reappears after study designs and technologies developed much further. Knowledge regarding SGLT2 (sodium glucose linked transporter 2) inhibitors has been increased enormously. The first two large randomized controlled trials with primary renal endpoints emerged and demonstrated a significantly slower progression of diabetic nephropathy postponing the initialization of chronic hemodialysis therapy by about 12 to 13 years. SGLT2 inhibitors can be used in type 2 and type 1 diabetic patients and patients with heart failure with or without diabetes. They decrease the systolic blood pressure independent of the basic blood pressure. However, this effect does not explain the improvement of cardiorenal endpoints. The nonsteroidal mineralocorticoid receptor antagonist (MRA) finerenone is protective for heart and kidneys in type 2 diabetic patients regarding cardiovascular mortality and kidney failure. As with classic MRAs hyperkalemia is seen with this substance as well, particularly in higher chronic kidney disease stages. Larger studies comparing classic MRAs do not exist. Finerenone approval in Germany is pending.