title: Intensification of blood pressure treatment in Pasifika people with type 2 diabetes and renal disease: a cohort study in primary care.
abstract: BACKGROUND
  Chronic kidney disease is common in Pasifika people with type 2 diabetes. Lowering blood pressure (BP) and reducing proteinuria may slow the rate of progression of renal disease.
  
  
  METHODS
  We conducted a 2-year study in patients with type 2 diabetes with estimated glomerular filtration rate (eGFR) greater than or equal to 40 ml/mmin/1.73 m² and urinary albumin-creatinine ratio (ACR) greater than or equal to 40 mg/mmol to evaluate a community-based programme aimed at optimising BP. Primary outcomes included BP reduction, remission of albuminuria and change in eGFR.
  
  
  RESULTS
  Thirty-nine of 47 patients completed greater than or equal to 17 months of intervention. The mean age was 53 plus or minus 8 years; 77% were male. An increase in antihypertensive therapy intensity was accompanied by a median (IQR) reduction in BP of 13[-1.5-22.5)/ 12(1-19) mmHg p<0.05] and urinary ACR (51(20-97) vs. 126(65-194) mg/mmol, p<0.05). Twelve (28%) of 43 patients achieving remission of albuminuria had a faster eGFR loss in the first year compared to the non-remitting group [13.6(4.0-16.6) vs. 3.5(-0.97-7.5) ml/min/1.73 m²/year, (p=0.02), but the rate of loss slowed in the second year. Two patients reached ESRF.
  
  
  CONCLUSIONS
  This community-based programme was effective in lowering BP and urinary ACR. In patients who achieved remission of albuminuria, a slower eGFR decline was observed after 12 months.
authors.affiliation: Auckland Diabetes Centre, Greenlane Clinical Centre, Level 1, Building 4, 214 Greenlane Road, Auckland 1023, New Zealand. jasmineta@adhb.govt.nz.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Tan
authors.forename: Fifita
authors.initials: F
authors.lastname: McCready
authors.forename: Fiona
authors.initials: F
authors.lastname: Noovao
authors.forename: Oketi
authors.initials: O
authors.lastname: Tepueluelu
authors.forename: John
authors.initials: J
authors.lastname: Collins
authors.forename: Tim
authors.initials: T
authors.lastname: Cundy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000208:ethnology; D003928:Diabetic Nephropathies / Q000208:ethnology / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology*; D060828:Induction Chemotherapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011320:Primary Health Care; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents