Key result
Systolic blood pressure <120 mmHg was associated with a significantly lower risk of macroalbuminuria compared with 130-140 mmHg in patients with type 1 diabetes (HR 0.59; 95% CI 0.37-0.95).
Why the study?
Do lower blood pressure levels (<120/70 mmHg) reduce the risk of adverse renal outcomes in patients with type 1 diabetes?
Cohort
Do lower blood pressure levels (<120/70 mmHg) reduce the risk of adverse renal outcomes in patients with type 1 diabetes?
Lower blood pressure (<120/70 mmHg) is associated with a substantially lower risk of adverse renal outcomes in type 1 diabetes, suggesting current targets of 140/90 mmHg may be too high.
May support SBP <120 mmHg targets in type 1 diabetes; hypothesis-generating and should not yet change practice.
OBJECTIVE: 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. RESEARCH DESIGN AND METHODS: ). RESULTS: 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). CONCLUSIONS: 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.
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Ku et al. (2016) conducted a cohort in Type 1 diabetes. Systolic blood pressure <120 mmHg vs. Systolic blood pressure 130-140 mmHg was evaluated on Macroalbuminuria (HR 0.59, 95% CI 0.37-0.95). Systolic blood pressure <120 mmHg was associated with a significantly lower risk of macroalbuminuria compared with 130-140 mmHg in patients with type 1 diabetes (HR 0.59; 95% CI 0.37-0.95).
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