Effects of Intensive Systolic Blood Pressure Lowering on End-Stage Kidney Disease and Kidney Function Decline in Adults With Type 2 Diabetes Mellitus and Cardiovascular Risk Factors: A Post Hoc Analysis of ACCORD-BP and SPRINT

Autor: Yahya M.K. Tawfik, Benjamin W. Van Tassell, Dave L. Dixon, William L. Baker, John Fanikos, Leo F. Buckley
Rok vydání: 2023
Předmět:
Zdroj: Diabetes Care. 46:868-873
ISSN: 1935-5548
0149-5992
DOI: 10.2337/dc22-2040
Popis: OBJECTIVETo determine the effects of intensive systolic blood pressure (SBP) lowering on the risk of major adverse kidney outcomes in people with type 2 diabetes mellitus (T2DM) and/or prediabetes and cardiovascular risk factors.RESEARCH DESIGN AND METHODSThis post hoc ACCORD-BP subgroup analysis included participants in the standard glucose-lowering arm with cardiovascular risk factors required for SPRINT eligibility. Cox proportional hazards regression models compared the hazard for the composite of dialysis, kidney transplant, sustained estimated glomerular filtration rate (eGFR) 3.3 mg/dL, or a sustained eGFR decline ≥57% between the intensive (RESULTSThe study cohort included 1,966 SPRINT-eligible ACCORD-BP participants (40% women) with a mean age of 63 years. The mean SBP achieved after randomization was 120 ± 14 and 134 ± 15 mmHg in the intensive and standard arms, respectively. The kidney composite outcome occurred at a rate of 9.5 and 7.2 events per 1,000 person-years in the intensive and standard BP arms (hazard ratio [HR] 1.35 [95% CI 0.85–2.14]; P = 0.20). Intensive SBP lowering did not affect the risk of moderately (HR 0.96 [95% CI 0.76–1.20]) or severely (HR 0.92 [95% CI 0.66–1.28]) increased albuminuria. Including SPRINT participants with prediabetes in the cohort did not change the overall results.CONCLUSIONSThis post hoc subgroup analysis suggests that intensive SBP lowering does not increase the risk of major adverse kidney events in individuals with T2DM and cardiovascular risk factors.
Databáze: OpenAIRE
Externí odkaz: