TY - JOUR
T1 - Lowering blood pressure reduces renal events in type 2 diabetes
AU - De Galan, Bastiaan E.
AU - Perkovic, Vlado
AU - Ninomiya, Toshiharu
AU - Pillai, Avinesh
AU - Patel, Anushka
AU - Cass, Alan
AU - Neal, Bruce
AU - Poulter, Neil
AU - Harrap, Stephen
AU - Mogensen, Carl Erik
AU - Cooper, Mark
AU - Marre, Michel
AU - Williams, Bryan
AU - Hamet, Pavel
AU - Mancia, Giuseppe
AU - Woodward, Mark
AU - Glasziou, Paul
AU - Grobbee, Diederick E.
AU - MacMahon, Stephen
AU - Chalmers, John
PY - 2009/4
Y1 - 2009/4
N2 - BP is an important determinant of kidney disease among patients with diabetes. The recommended thresholds to initiate treatment to lower BP are 130/80 and 125/75 mmHg for people with diabetes and nephropathy, respectively. We sought to determine the effects of lowering BP below these currently recommended thresholds on renal outcomes among 11,140 patients who had type 2 diabetes and participated in the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study. Patients were randomly assigned to fixed combination perindopril-indapamide or placebo, regardless of their BP at entry. During a mean follow-up of 4.3 yr, active treatment reduced the risk for renal events by 21% (P < 0.0001), which was driven by reduced risks for developing microalbuminuria and macroalbuminuria (both P < 0.003). Effects of active treatment were consistent across subgroups defined by baseline systolic or diastolic BP. Lower systolic BP levels during follow-up, even to <110 mmHg, was associated with progressively lower rates of renal events. In conclusion, BP-lowering treatment with perindopril-indapamide administered routinely to individuals with type 2 diabetes provides important renoprotection, even among those with initial BP <120/70 mmHg. We could not identify a BP threshold below which renal benefit is lost.
AB - BP is an important determinant of kidney disease among patients with diabetes. The recommended thresholds to initiate treatment to lower BP are 130/80 and 125/75 mmHg for people with diabetes and nephropathy, respectively. We sought to determine the effects of lowering BP below these currently recommended thresholds on renal outcomes among 11,140 patients who had type 2 diabetes and participated in the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study. Patients were randomly assigned to fixed combination perindopril-indapamide or placebo, regardless of their BP at entry. During a mean follow-up of 4.3 yr, active treatment reduced the risk for renal events by 21% (P < 0.0001), which was driven by reduced risks for developing microalbuminuria and macroalbuminuria (both P < 0.003). Effects of active treatment were consistent across subgroups defined by baseline systolic or diastolic BP. Lower systolic BP levels during follow-up, even to <110 mmHg, was associated with progressively lower rates of renal events. In conclusion, BP-lowering treatment with perindopril-indapamide administered routinely to individuals with type 2 diabetes provides important renoprotection, even among those with initial BP <120/70 mmHg. We could not identify a BP threshold below which renal benefit is lost.
UR - http://www.scopus.com/inward/record.url?scp=65249111029&partnerID=8YFLogxK
U2 - 10.1681/ASN.2008070667
DO - 10.1681/ASN.2008070667
M3 - Article
C2 - 19225038
AN - SCOPUS:65249111029
SN - 1046-6673
VL - 20
SP - 883
EP - 892
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 4
ER -