title: Effects of intensified antihypertensive treatment in diabetic nephropathy: mortality and morbidity results of a prospective controlled 10-year study.
abstract: 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.
authors.affiliation: Department of Metabolic Diseases and Nutrition (WHO-Collaborating Centre for Diabetes), Heinrich-Heine-University of Düsseldorf, Germany.
authors.forename: A K
authors.initials: AK
authors.lastname: Trocha
authors.forename: C
authors.initials: C
authors.lastname: Schmidtke
authors.forename: U
authors.initials: U
authors.lastname: Didjurgeit
authors.forename: I
authors.initials: I
authors.lastname: Mühlhauser
authors.forename: R
authors.initials: R
authors.lastname: Bender
authors.forename: M
authors.initials: M
authors.lastname: Berger
authors.forename: P T
authors.initials: PT
authors.lastname: Sawicki
mesh_terms: 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
chemical_list: D000959:Antihypertensive Agents