title: The effects of blood pressure control levels on the renoprotection of type 2 diabetic patients without overt proteinuria.
abstract: BACKGROUND
  There is little evidence regarding the target blood pressure level in patients with type 2 diabetes mellitus without overt proteinuria.
  
  
  RESULTS
  We followed 608 Japanese patients with type 2 diabetes without apparent cardiovascular disease and overt proteinuria who underwent cerebral magnetic resonance imaging for a mean of 7.5 years. The patients were categorized according to their mean systolic blood pressure during the follow-up period (strict: <130 mm Hg, moderate: ≥130 and <140 mm Hg, poor: ≥ 140 mm Hg). The risks for the primary composite outcome of death or end-stage renal disease were not different among the three groups. The renal risk of the doubling of serum creatinine for the poor group was significantly higher than those in other groups. In addition, among the patients without silent cerebral infarction (SCI), the renal risk was significantly lower in the strict group than in the moderate group. Further, in both the SCI and non-SCI groups, strict blood pressure control slowed the progression of albuminuria.
  
  
  CONCLUSIONS
  In nonproteinuric diabetic patients without SCI, strict blood pressure control was associated with improved renal outcomes. There may be different effects of intensive blood pressure control on the renoprotection of diabetic patients according to their complications.
authors.affiliation: Shiga University of Medical Science, Otsu, Shiga, Japan. takuzu@belle.shiga-med.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Uzu
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kida
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamauchi
authors.forename: Shinji
authors.initials: S
authors.lastname: Kume
authors.forename: Keiji
authors.initials: K
authors.lastname: Isshiki
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Araki
authors.forename: Daisuke
authors.initials: D
authors.lastname: Koya
authors.forename: Masakazu
authors.initials: M
authors.lastname: Haneda
authors.forename: Atsunori
authors.initials: A
authors.lastname: Kashiwagi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Maegawa
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Kikkawa
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D002544:Cerebral Infarction / Q000401:mortality / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000401:mortality* / Q000517:prevention & control*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006977:Hypertension, Renal / Q000188:drug therapy* / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011507:Proteinuria; D012307:Risk Factors