title: Pulse pressure is not an independent predictor of outcome in type 2 diabetes patients with chronic kidney disease and anemia--the Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT).
abstract: Pulse pressure (PP) remains an elusive cardiovascular risk factor with inconsistent findings. We clarified the prognostic value in patients with type 2 diabetes, chronic kidney disease (CKD) and anemia in the Trial to Reduce cardiovascular Events with Aranesp (darbepoetin alfa) Therapy. In 4038 type 2 diabetes patients, darbepoetin alfa treatment did not affect the primary outcome. Risk related to PP at randomization was evaluated in a multivariable model including age, gender, kidney function, cardiovascular disease (CVD) and other conventional risk factors. End points were myocardial infarction (MI), stroke, end stage renal disease (ESRD) and the composite of cardiovascular death, MI or hospitalization for myocardial ischemia, heart failure or stroke (CVD composite). Median (interquartile range) age, gender, eGFR and PP was 68 (60-75) years, 57.3% women, 33 (27-42) ml min(-1) per 1.73 m2 and 60 (50-74) mm Hg. During 29.1 months (median) follow-up, the number of events for composite CVD, MI, stroke and ESRD was 1010, 253, 154 and 668. In unadjusted analyses, higher quartiles of PP were associated with higher rates per 100 years of follow-up of all end points (P⩽0.04), except stroke (P=0.52). Adjusted hazard ratios (95% confidence interval) per one quartile increase in PP were 1.06 (0.99-1.26) for MI, 0.96 (0.83-1.11) for stroke, 1.01 (0.94-1.09) for ESRD and 1.01 (0.96-1.07) for CVD composite. Results were similar in continuous analyses of PP (per 10 mm Hg). In patients with type 2 diabetes, CKD and anemia, PP did not independently predict cardiovascular events or ESRD. This may reflect confounding by aggressive antihypertensive treatment, or PP may be too rough a risk marker in these high-risk patients.
authors: Steno Diabetes Center, Gentofte, Denmark.
authors: S
authors: S
authors: Theilade
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|Division of Cardiovascular Medicine, Brigham Women's Hospital, Boston, MA, USA.
authors: B
authors: B
authors: Claggett
authors: Steno Diabetes Center, Gentofte, Denmark.
authors: T W
authors: TW
authors: Hansen
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|Division of Cardiovascular Medicine, Brigham Women's Hospital, Boston, MA, USA.
authors: H
authors: H
authors: Skali
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|Division of Cardiovascular Medicine, Brigham Women's Hospital, Boston, MA, USA.
authors: E F
authors: EF
authors: Lewis
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|Division of Cardiovascular Medicine, Brigham Women's Hospital, Boston, MA, USA.
authors: S D
authors: SD
authors: Solomon
authors: Department of Medical Endocrinology, Rigshospitalet, Copenhagen, Denmark.|Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.|Faculty of Health Sciences, Aarhus University, Aarhus, Denmark.
authors: H-H
authors: HH
authors: Parving
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|Division of Cardiovascular Medicine, Brigham Women's Hospital, Boston, MA, USA.
authors: M
authors: M
authors: Pfeffer
authors: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors: J J
authors: JJ
authors: McMurray
authors: Steno Diabetes Center, Gentofte, Denmark.|Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.|Faculty of Health Sciences, Aarhus University, Aarhus, Denmark.
authors: P
authors: P
authors: Rossing
mesh_terms: D000367:Age Factors; D000368:Aged; D000740:Anemia / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D001794:Blood Pressure / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology*; D000068256:Darbepoetin alfa / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D006397:Hematinics; D000068256:Darbepoetin alfa