title: Effects of blood pressure on renal and cardiovascular outcomes in Asian patients with type 2 diabetes and overt nephropathy: a post hoc analysis (ORIENT-blood pressure).
abstract: BACKGROUND
  Blood pressure (BP) control may have different effects on cardiovascular (CV) and renal outcomes in diabetes. We examined the impact of systolic BP (SBP) on renal and CV outcomes in a post hoc analysis in the Olmesartan Reducing Incidence of Endstage Renal Disease in Diabetic Nephropathy Trial.
  
  
  METHODS
  We stratified mean follow-up SBP into three categories (≤130, 131-140 and >140 mmHg) and used a Cox regression model to estimate the hazard ratio (HR, 95% confidence interval) for the outcomes. The composite renal outcome was doubling of serum creatinine, end-stage renal disease and all-cause death. The composite CV outcome included CV death, nonfatal stroke, nonfatal myocardial infarction, hospitalization for unstable angina or heart failure, revascularization and lower extremity amputation. We also compared the slope of estimated glomerular filtration rate (eGFR) in all three groups.
  
  
  RESULTS
  After a mean follow-up period of 3.2 years, the follow-up SBP was linearly associated with risk of renal outcomes in all 566 patients. In patients with heavy proteinuria (≥1 g/gCr), a follow-up SBP > 130 mmHg was associated with an HR of 2.33 (1.62-3.36) for renal outcomes with referent to SBP ≤ 130 mmHg. In patients without history of CV disease, a follow-up SBP > 140 mmHg was associated with an HR of 2.04 (1.23-3.40) for CV outcomes with referent to SBP < 140 mmHg. The median (interquartile range) slopes of eGFR were -3.27 (-6.90, -1.63), -4.53 (-8.08, -2.29) and -7.13 (-10.90, -3.99) dL/mg/year in patients with SBP ≤ 130, 131-140 and > 140 mmHg, respectively (P = 0.008 between ≤130 and 131-140, P < 0.001 between ≤ 130 and > 140 mmHg).
  
  
  CONCLUSIONS
  In Asian type 2 diabetic patients with chronic kidney disease and heavy proteinuria, reduction of SBP ≤ 130 mmHg was associated with greater renoprotection than cardioprotection. However, our results emphasize the need to individualize BP targets in type 2 diabetes.
authors.affiliation: Nakayamadera Imai Clinic, Takarazuka, Japan Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Enyu
authors.initials: E
authors.lastname: Imai
authors.affiliation: Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Clinical Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Sadayoshi
authors.initials: S
authors.lastname: Ito
authors.affiliation: Second Department of Medicine, Asahikawa University of Medical Science, Asahikawa, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Haneda
authors.affiliation: Daiichi Sankyo Company Ltd., Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Harada
authors.affiliation: Daiichi Sankyo Company Ltd., Tokyo, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Kobayashi
authors.affiliation: Daiichi Sankyo Company Ltd., Tokyo, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Yamasaki
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Makino
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong Institute of Diabetes and Obesity, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China Department of Medicine and Therapeutics, Prince of Wales Hospital, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
authors.forename: Juliana C N
authors.initials: JC
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends
keywords: cardiovascular outcome; diabetic nephropathy; proteinuria; renal outcome; systolic blood pressure