Systolic BP Predicts Diabetic
Nephropathy Progression
Findings provide strong support for aggressive
BP reduction for people with nephropathy from
type 2 diabetes.
Dr. George L. Bakris, of Rush Medical College,
Chicago, colleagues used a Cox proportional hazards
regression model to examine the effects of baseline
systolic blood pressure, diastolic blood pressure,
and pulse pressure on renal outcomes in patients
with established nephropathy and hypertension
associated with type 2 diabetes. Included were
1513 patients enrolled in the Reduction of Endpoints
in NIDDM (non-insulin dependent diabetes mellitus)
with the Angiotensin II Antagonist Losartan (RENAAL)
study.
The main outcome measures were doubling of serum
creatinine, end-stage renal disease (ESRD), or
death. The team also examined the effects of the
angiotensin receptor blocker losartan potassium
on composite and renal outcomes.
Compared with patients with baseline systolic
blood pressure below 130 mm Hg, those with a baseline
systolic blood pressure between 140 and 159 mm
Hg had a 38% increased risk of ESRD (p < 0.01).
The risk more than doubled in patients with systolic
blood pressure levels at least 160 mm Hg (p <
0.001).
Multivariate analysis demonstrated that the risk
for ESRD or death increased by 6.7% for every
10-mm Hg rise in baseline systolic blood pressure
(p = 0.007). After adjusting for urinary albumin-creatinine
ratio, serum creatinine, serum albumin, hemoglobin
A1c, and hemoglobin, every 10-mm Hg rise in diastolic
blood pressure decreased the risk by 10.9% (p
= 0.01).
"Those randomized to the losartan group with
a baseline pulse pressure above 90 mm Hg had a
53.5% risk reduction for ESRD alone (p = 0.003)
and a 35.5% risk reduction for ESRD or death (p
= 0.02) compared with the placebo group,"
Dr. Bakris and colleagues report.
The findings provide strong support for aggressive
BP reduction for people with nephropathy from
type 2 diabetes. Arch Intern Med 2003;163:1555-1565.
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