Adverse effects of left ventricular hypertrophy in the reduction of endpoints in NIDDM with the angiotensin II antagonist losartan (RENAAL) study

Autor: Renaal Study Investigators, Tania Z. Dickson, K McCarroll, G Boner, de Dick Zeeuw, Barry M. Brenner, H. H. Parving, Mark E. Cooper, Peter R. Kowey, R S Crow, Shahnaz Shahinfar
Přispěvatelé: Groningen Kidney Center (GKC)
Rok vydání: 2005
Předmět:
Male
Endocrinology
Diabetes and Metabolism
progression of renal disease
Left ventricular hypertrophy
RANDOMIZED TRIAL
Muscle hypertrophy
Diabetic nephropathy
Electrocardiography
HYPERTENSIVE PATIENTS
Diabetic Nephropathies
RISK
Angiotensin II
Middle Aged
left ventricular hypertrophy
Losartan
Treatment Outcome
CARDIOVASCULAR-DISEASE
Cardiovascular Diseases
cardiovascular system
Cardiology
Female
Hypertrophy
Left Ventricular
type 2 diabetes
INTERVENTION
hormones
hormone substitutes
and hormone antagonists
circulatory and respiratory physiology
medicine.drug
medicine.medical_specialty
Endpoint Determination
Risk Assessment
Nephropathy
Diabetes Complications
cardiovascular events
MORBIDITY
MASS INDEX
Double-Blind Method
Internal medicine
Diabetes mellitus
Internal Medicine
medicine
Humans
cardiovascular diseases
Antihypertensive Agents
Aged
business.industry
diabetic nephropathy
medicine.disease
DIABETIC-PATIENTS
LIFE
PROGNOSTIC IMPLICATIONS
Endocrinology
Diabetes Mellitus
Type 2
business
Kidney disease
Zdroj: Diabetologia, 48(10), 1980-1987. SPRINGER
ISSN: 0012-186X
Popis: Aims/hypothesis: We explored the impact of baseline left ventricular hypertrophy (LVH) and losartan treatment on renal and cardiovascular (CV) events in 1,513 patients from the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial, which studied the effects of losartan on the progression of renal disease and/or death in patients with type 2 diabetes and nephropathy. Materials and methods: LVH was assessed using ECG criteria (Cornell product and/or Sokolow-Lyon voltage). The risk of renal or CV events was determined by a proportional hazards model fit with treatment allocation and presence of LVH. Covariates at baseline included age, sex, systolic BP, mean arterial pressure, pulse, proteinuria, serum creatinine, albumin and haemoglobin. Results: A total of 187 subjects (12%) had LVH at baseline. Treatment with losartan resulted in a significant decrease in the Cornell product (-6.2%) and Sokolow-Lyon voltage (-6.3%). LVH was shown to be significantly associated with the primary endpoint, which was a composite of doubling of serum creatinine (DSCR), endstage renal disease (ESRD) or death (hazard ratio [HR]=1.44, p=0.011), as well as with the composite renal endpoint of DSCR/ESRD (HR=1.42, p=0.031) and CV events (HR=1.68, p=0.001). Losartan treatment of patients with LVH decreased the CV as well as renal risk to a level similar to that of patients without LVH. Conclusions/interpretation: In patients with type 2 diabetes and nephropathy, LVH is associated with significantly increased risk of CV events and the progression of kidney disease. Importantly, in patients with LVH, losartan reduced the CV as well as the renal risk to a level similar to that seen in subjects without LVH.
Databáze: OpenAIRE
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