Lowering blood pressure reduces renal events in type 2 diabetes.
BP is an important determinant of kidney disease among patients with diabetes. The recommended thresholds to initiate treatment to lower BP are 130/80 and 125/75 mmHg for people with diabetes and nephropathy, respectively. We sought to determine the effects of lowering BP below these currently recommended thresholds on renal outcomes among 11,140 patients who had type 2 diabetes and participated in the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study. Patients were randomly assigned to fixed combination perindopril-indapamide or placebo, regardless of their BP at entry. During a mean follow-up of 4.3 yr, active treatment reduced the risk for renal events by 21% (P < 0.0001), which was driven by reduced risks for developing microalbuminuria and macroalbuminuria (both P < 0.003). Effects of active treatment were consistent across subgroups defined by baseline systolic or diastolic BP. Lower systolic BP levels during follow-up, even to <110 mmHg, was associated with progressively lower rates of renal events. In conclusion, BP-lowering treatment with perindopril-indapamide administered routinely to individuals with type 2 diabetes provides important renoprotection, even among those with initial BP <120/70 mmHg. We could not identify a BP threshold below which renal benefit is lost.
de Galan
Bastiaan E
BE
George Institute for International Health, University of Sydney, Sydney, NSW, Australia.
Perkovic
Vlado
V
Ninomiya
Toshiharu
T
Pillai
Avinesh
A
Patel
Anushka
A
Cass
Alan
A
Neal
Bruce
B
Poulter
Neil
N
Harrap
Stephen
S
Mogensen
Carl-Erik
CE
Cooper
Mark
M
Marre
Michel
M
Williams
Bryan
B
Hamet
Pavel
P
Mancia
Giuseppe
G
Woodward
Mark
M
Glasziou
Paul
P
Grobbee
Diederick E
DE
MacMahon
Stephen
S
Chalmers
John
J
D017668:Age of Onset; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000517:prevention & control*; D003971:Diastole / Q000187:drug effects / Q000502:physiology; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D007190:Indapamide / Q000627:therapeutic use*; D008297:Male; D020913:Perindopril / Q000627:therapeutic use*; D013599:Systole / Q000187:drug effects / Q000502:physiology
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D003404:Creatinine; D007190:Indapamide; D020913:Perindopril