title: Association Between Blood Pressure and Adverse Renal Events in Type 1 Diabetes.
abstract: To compare different blood pressure (BP) levels in their association with the risk of renal outcomes in type 1 diabetes and to determine whether an intensive glycemic control strategy modifies this association.
  
  
  
  We included 1,441 participants with type 1 diabetes between the ages of 13 and 39 years who had previously been randomized to receive intensive versus conventional glycemic control in the Diabetes Control and Complications Trial (DCCT). The exposures of interest were time-updated systolic BP (SBP) and diastolic BP (DBP) categories. Outcomes included macroalbuminuria (>300 mg/24 h) or stage III chronic kidney disease (CKD) (sustained estimated glomerular filtration rate <60 mL/min/1.73 m2).
  
  
  
  During a median follow-up time of 24 years, there were 84 cases of stage III CKD and 169 cases of macroalbuminuria. In adjusted models, SBP in the <120 mmHg range was associated with a 0.59 times higher risk of macroalbuminuria (95% CI 0.37-0.95) and a 0.32 times higher risk of stage III CKD (95% CI 0.14-0.75) compared with SBPs between 130 and 140 mmHg. DBP in the <70 mmHg range were associated with a 0.73 times higher risk of macroalbuminuria (95% CI 0.44-1.18) and a 0.47 times higher risk of stage III CKD (95% CI 0.21-1.05) compared with DBPs between 80 and 90 mmHg. No interaction was noted between BP and prior DCCT-assigned glycemic control strategy (all P > 0.05).
  
  
  
  A lower BP (<120/70 mmHg) was associated with a substantially lower risk of adverse renal outcomes, regardless of the prior assigned glycemic control strategy. Interventional trials may be useful to help determine whether the currently recommended BP target of 140/90 mmHg may be too high for optimal renal protection in type 1 diabetes.
authors.affiliation: Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA elaine.ku@ucsf.edu.|Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Ku
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: McCulloch
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, University of Minnesota, Minneapolis, MN.
authors.forename: Michael
authors.initials: M
authors.lastname: Mauer
authors.affiliation: Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Gitelman
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Grimes
authors.affiliation: Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA.
authors.forename: Chi-Yuan
authors.initials: CY
authors.lastname: Hsu
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D055815:Young Adult; D000419:Albuminuria / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007668:Kidney / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic
chemical_list: D000959:Antihypertensive Agents; D001786:Blood Glucose; D007004:Hypoglycemic Agents