Key result
Apparent treatment resistant hypertension in patients with type 2 diabetes was associated with an increased risk of developing low estimated glomerular filtration rate (OR 1.31; P<0.001).
Why the study?
Does apparent treatment resistant hypertension and strict blood pressure control affect the risk of renal function decline in patients with type 2 diabetes and hypertension?
Cohort (n=29,923)
Does apparent treatment resistant hypertension and strict blood pressure control affect the risk of renal function decline in patients with type 2 diabetes and hypertension?
Apparent treatment resistant hypertension is associated with a higher risk of renal function decline in patients with type 2 diabetes, and strict blood pressure control (<140/90 mm Hg) in these patients may paradoxically increase this risk.
Strict blood pressure control in this population may paradoxically accelerate renal decline; leaves open whether relaxed targets preserve.
Background Apparent treatment resistant hypertension ( aTRH ) is highly prevalent in patients with type 2 diabetes mellitus (T2D) and entails worse cardiovascular prognosis. The impact of aTRH and long‐term achievement of recommended blood pressure ( BP ) values on renal outcome remains largely unknown. We assessed the role of aTRH and BP on the development of chronic kidney disease in patients with T2D and hypertension in real‐life clinical practice. Methods and Results Clinical records from a total of 29 923 patients with T2D and hypertension, with normal baseline estimated glomerular filtration rate and regular visits during a 4‐year follow‐up, were retrieved and analyzed. The association between time‐updated BP control (ie, 75% of visits with BP <140/90 mm Hg) and the occurrence of estimated glomerular filtration rate <60 and/or a reduction ≥30% from baseline was assessed. At baseline, 17% of patients had aTRH . Over the 4‐year follow‐up, 19% developed low estimated glomerular filtration rate and 12% an estimated glomerular filtration rate reduction ≥30% from baseline. Patients with aTRH showed an increased risk of developing both renal outcomes (adjusted odds ratio, 1.31 and 1.43; P <0.001 respectively), as compared with those with non‐ aTRH . No association was found between BP control and renal outcomes in non‐ aTRH , whereas in aTRH , BP control was associated with a 30% ( P =0.036) greater risk of developing the renal end points. Conclusions ATRH entails a worse renal prognosis in T2D with hypertension. BP control is not associated with a more‐favorable renal outcome in aTRH . The relationship between time‐updated BP and renal function seems to be J‐shaped, with optimal systolic BP values between 120 and 140 mm Hg.
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Viazzi et al. (2017) conducted a cohort in Type 2 diabetes mellitus and hypertension (n=29,923). Apparent treatment resistant hypertension (aTRH) vs. Non-aTRH was evaluated on Estimated glomerular filtration rate <60 (OR 1.31, p=<0.001). Apparent treatment resistant hypertension in patients with type 2 diabetes was associated with an increased risk of developing low estimated glomerular filtration rate (OR 1.31; P<0.001).
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