Albuminuria and blood pressure, independent targets for cardioprotective therapy in patients with diabetes and nephropathy: a post hoc analysis of the combined RENAAL and IDNT trials
Key result
Initial reductions in systolic blood pressure and albuminuria independently correlated with cardiovascular protection (HR per 5 mmHg SBP reduction 0.97, 95% CI 0.94-0.99; HR per decrement log albuminuria 0.87, 95% CI 0.76-0.99).
Why the study?
Does the reduction of both systolic blood pressure and albuminuria with angiotensin receptor blockers improve cardiovascular outcomes in patients with diabetes and nephropathy?
Population
Patients with diabetes and nephropathy from the combined RENAAL and IDNT trials
Design
Cohort
Authors
Discussion
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Implication
May support dual SBP-albuminuria targeting in diabetic nephropathy; hypothesis-generating for ARB optimization pending RCTs.
Study Design
Type
Observational
Structured PICO
Does the reduction of both systolic blood pressure and albuminuria with angiotensin receptor blockers improve cardiovascular outcomes in patients with diabetes and nephropathy?
P
Population
Patients with diabetes and nephropathy from the combined RENAAL and IDNT trials, evaluated for systolic blood pressure and albuminuria response to ARB therapy.
E
Exposure
Angiotensin receptor blockers (ARBs)
O
Outcome
Cardiovascular outcomeshard clinical
Main Result
Hazard Ratio: 0.97 (95% CI 0.94–0.99)
Systolic blood pressure and albuminuria responses to ARB therapy are discordant, suggesting that dual targeting of both parameters is necessary for optimal cardiovascular protection in diabetic nephropathy.
Cite This Study
Holtkamp et al. (2011) conducted an observational in diabetes and nephropathy. Reduction in systolic blood pressure and albuminuria was evaluated on cardiovascular outcomes (HR 0.97, 95% CI 0.94-0.99). Initial reductions in systolic blood pressure and albuminuria independently correlated with cardiovascular protection (HR per 5 mmHg SBP reduction 0.97, 95% CI 0.94-0.99; HR per decrement log albuminuria 0.87, 95% CI 0.76-0.99).