Familial Hypertension And Renal Disease

The frequent association of renal disease with hypertension has led to the examination of blood pressure in non-diabetic family members of persons with diabetes and in individuals thought to be at high risk of developing diabetes in the future. Viberti et al. found that both systolic and diastolic blood pressures were significantly higher in the parents of diabetic subjects with proteinuria

than in the parents of diabetic subjects without proteinuria [29]. The difference between the mean blood pressures averaged 15 mmHg. Similarly, Krolewski et al. [30] reported that the risk of nephropathy among subjects with type 1 diabetes was three times as high in those having a parent with a history of hypertension as in those whose parents had no such history, and Takeda et al.

[31] found evidence suggesting that paternal hypertension might be related to the development of nephropathy in patients with type 2 diabetes. Beatty et al.

[32] found more insulin resistance as well as higher blood pressures in the offspring of hypertensive than of normotensive parents. These offspring, therefore, are presumably at increased risk of developing diabetes. Since they already have significantly higher blood pressures, they may be at particular risk of renal disease if they do develop diabetes.

Among diabetic Pima Indians whose parents did not have proteinuria, those with hypertensive parents had a higher prevalence of proteinuria than those with normotensive parents [33]. This finding was observed even among those with nondiabetic parents (figure 4). Moreover, higher mean blood pressure measured at least one year prior to the onset of diabetes predicted an abnormal urinary excretion of albumin determined after the diagnosis of diabetes [34]. Thus, the hypertension so often associated with diabetic nephropathy cross-sectionally does not appear to be entirely a result of the renal disease. This hypertension, which appears to be familial in several studies, may precede and contribute to the renal disease seen after several years of diabetes in some subjects.

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