Effects of intensified antihypertensive treatment in diabetic nephropathy
| Autor: | Michael F. Berger, Claudia Schmidtke, Ingrid Mühlhauser, U. Didjurgeit, Ralf Bender, Peter T. Sawicki, Anna K. Trocha |
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| Rok vydání: | 1999 |
| Předmět: |
Adult
Male medicine.medical_specialty Physiology medicine.medical_treatment Nephropathy Diabetic nephropathy Internal medicine Diabetes mellitus Internal Medicine medicine Humans Diabetic Nephropathies Prospective Studies Prospective cohort study Antihypertensive Agents Dialysis business.industry Odds ratio Middle Aged medicine.disease Survival Analysis Confidence interval Surgery Diabetes Mellitus Type 1 Hypertension Female Cardiology and Cardiovascular Medicine business Follow-Up Studies Kidney disease |
| Zdroj: | Journal of Hypertension. 17:1497-1503 |
| ISSN: | 0263-6352 |
| Popis: | The aim of this study was to describe the effect of intensified antihypertensive therapy based on a structured teaching and treatment programme on the prognosis of hypertensive type 1 (insulin-dependent) diabetic patients with kidney disease.The study was a controlled, prospective, parallel, 10-year follow-up trial.A sequential sample of 91 hypertensive type 1 diabetic patients with overt diabetic nephropathy was prospectively followed for 10 years. Forty-five patients (intensified antihypertensive therapy; IT group) participated in an intensified antihypertensive therapy programme and 46 patients received routine antihypertensive treatment as provided by family physicians, consultants and local hospitals (routine antihypertensive therapy; RT group).The main endpoint was death; secondary endpoints were renal replacement therapy, blindness and amputation.Blood pressure was reduced in the IT group and increased in the RT group. During the follow-up period, 29 patients died, seven in the IT group and 22 in the RT group. The survival curves were significantly different (P = 0.0008). The main causes of death were cardiac. In a multiple Cox proportional hazards model, allocation to the IT group reduced the mortality risk [relative risk (RR) = 0.213; 95% confidence interval 0.089-0.509, P = 0.00051, while age (P = 0.0039) and mean blood pressure (P= 0.0113) increased this risk. In multiple Cox or multiple logistic regression models, the risks of dialysis (RR = 0.269, 95% confidence interval 0.110-0.656, P = 0.0039), blindness (odds ratio = 0.158, 95% confidence interval 0.037-0.684, P= 0.0136), and amputation (RR = 0.181, 95% confidence interval 0.047-0.703, P= 0.0135) were significantly lower in the IT group compared with the RT group (log rank P = 0.0008).We conclude that intensified antihypertensive treatment, based on a hypertension teaching and treatment programme, reduces long-term morbidity and mortality in patients with diabetic nephropathy. |
| Databáze: | OpenAIRE |
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