title: Impact of achieved blood pressure on cardiovascular outcomes in the Irbesartan Diabetic Nephropathy Trial.
abstract: Elevated arterial pressure enhances the risk for cardiovascular (CV) events in patients with diabetic nephropathy. The optimal BP and the component of the elevated BP that affect the risk have not been defined. A post hoc analysis was performed to assess the impact of achieved systolic, diastolic, and pulse pressures on CV outcomes in 1590 adults who had overt diabetic nephropathy and were enrolled in the Irbesartan Diabetic Nephropathy Trial (IDNT) and had a baseline serum creatinine above the normal range, up to 266 micromol/L (3.0 mg/dL), 24-h urine protein >900 mg/d, and at least 6 mo of follow-up. Patients were randomized to irbesartan, amlodipine, or placebo, with other antihypertensive agents to a BP goal of < or =135/85 mmHg. Progressively lower achieved systolic BP (SBP) to 120 mmHg predicted a decrease in CV mortality and congestive heart failure (CHF) but not myocardial infarctions (MI). A SBP below this threshold was associated with increased risk for CV deaths and CHF events. Achieved diastolic BP <85 mmHg was associated with a trend to increase in all-cause mortality, significant increase in MI, but decreased risk for strokes. Increased pulse pressure predicted increased all-cause mortality, CV mortality, MI, and CHF. It is concluded that achieved SBP approaching 120 mmHg and diastolic BP of 85 mmHg are associated with the best protection against CV events in these patients. BP < or =120/85 may be associated with an increase in CV events.
authors.affiliation: University of Colorado Health Sciences Center, 4200 East 9th Avenue, C-281, Denver, CO 80262, USA. tomas.berl@uchsc.edu
authors.forename: Tomas
authors.initials: T
authors.lastname: Berl
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Hunsicker
authors.forename: Julia B
authors.initials: JB
authors.lastname: Lewis
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.forename: Jerome G
authors.initials: JG
authors.lastname: Porush
authors.forename: Jean-Lucien
authors.initials: JL
authors.lastname: Rouleau
authors.forename: Paul L
authors.initials: PL
authors.lastname: Drury
authors.forename: Enric
authors.initials: E
authors.lastname: Esmatjes
authors.forename: Donald
authors.initials: D
authors.lastname: Hricik
authors.forename: Marc
authors.initials: M
authors.lastname: Pohl
authors.forename: Itamar
authors.initials: I
authors.lastname: Raz
authors.forename: Philippe
authors.initials: P
authors.lastname: Vanhille
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Wiegmann
authors.forename: Bernard M
authors.initials: BM
authors.lastname: Wolfe
authors.forename: Francesco
authors.initials: F
authors.lastname: Locatelli
authors.forename: Samuel Z
authors.initials: SZ
authors.lastname: Goldhaber
authors.forename: Edmund J
authors.initials: EJ
authors.lastname: Lewis
mesh_terms: D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001713:Biphenyl Compounds / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D003928:Diabetic Nephropathies / Q000150:complications*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D000077405:Irbesartan; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D013777:Tetrazoles / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D013777:Tetrazoles; D000077405:Irbesartan