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Lowering BP reduces risk of renal events in patients with type 2 diabetes, regardless of baseline BP, findings show
Tuesday, March 17 2009 | Comments
What's This?
Reducing blood pressure (BP) with the combination of an angiotensin-converting enzyme inhibitor and a diuretic seems to reduce the risk of renal events in patients with type 2 diabetes, even in patients with BP levels below currently recommended targets, according to an analysis of renal outcomes in the ADVANCE trial.During the ADVANCE trial, 11,140 individuals aged >=55 years with type 2 diabetes were randomized to receive perindopril plus indapamide (2 mg/0.625 mg for the first 3 months, with the dosage doubled thereafter) or placebo. The researchers noted that the trial had no inclusion or exclusion criteria with regard to BP, albuminuria rate, renal function, or use of BP-lowering agents.
The main outcome of the analysis was a composite of renal outcome events (new-onset microalbuminuria, new-onset nephropathy, doubling of serum creatinine levels to >200 mcmol/L, or end-stage renal disease).
During a mean follow-up of 4.3 years, active treatment reduced the risk of the composite outcome measure by 21% (hazard ratio [HR], 0.79; 95% CI, 0.73-0.85; P<.0001). This reduction in risk, the authors noted, was driven primarily by reduced risks of both micro- and macroalbuminuria.
The effects of treatment were consistent in subgroup analyses of patients stratified by baseline BP, even in those patients with a baseline BP of <120/70 mm Hg.
"In absolute terms, this simple, well-tolerated treatment strategy prevented 1 renal event among every 20 patients who were treated for 5 years, with no selection of patients on the basis of BP or BP-lowering treatment," the authors concluded. "These data therefore suggest that BP lowering may be considered routinely for the prevention of renal complications in all patients with diabetes, regardless of the baseline BP level."
This article was published online Feb. 18 ahead of print in the Journal of the American Society of Nephrology by de Galan BE, et al.
This research was funded in part by Servier.
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