Effects of intensified antihypertensive treatment in diabetic nephropathy: mortality and morbidity results of a prospective controlled 10-year study.
OBJECTIVE
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.


METHODS
The study was a controlled, prospective, parallel, 10-year follow-up trial.


METHODS
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).


METHODS
The main endpoint was death; secondary endpoints were renal replacement therapy, blindness and amputation.


RESULTS
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).


CONCLUSIONS
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.
Trocha
A K
AK
Department of Metabolic Diseases and Nutrition (WHO-Collaborating Centre for Diabetes), Heinrich-Heine-University of Düsseldorf, Germany.
Schmidtke
C
C
Didjurgeit
U
U
Mühlhauser
I
I
Bender
R
R
Berger
M
M
Sawicki
P T
PT
D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016019:Survival Analysis
D000959:Antihypertensive Agents